FORM 1023-EZ for NW BALLERZ

Field Data
EIN 84-3642301
Case Number EO-2019325-000200
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NW BALLERZ
Organization’s Mailing Address 3385 PORTSHIRE CT
City HOFFMAN ESTATES
State IL
ZIP 60067
Accounting period End 12
Primary contact name JIBY VETTICKAL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JIBY VETTICKAL
OFFICER
3385 PORTSHIRE CT
HOFFMAN ESTATES IL 60067-4740

Officer/Director/Trustee Two

ANIL PATEL
OFFICER
5131 DUPONT AVE
PALATINE IL 60067

Officer/Director/Trustee Three

NIPESH PATEL
OFFICER
3594 HAROLD CIRCLE
HOFFMAN ESTATES IL 60192

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/11/19
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N62 - Basketball
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JIBY VETTICKAL
Signature Title OFFICER
Signature Date 11/19/19

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