FORM 1023-EZ for CLUB BLUE OF THE HAMPTON ROADS INC

Field Data
EIN 85-2671187
Case Number EO-2021102-001026
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLUB BLUE OF THE HAMPTON ROADS INC
Organization’s Mailing Address 254 CEDAR ROAD
City POQUOSON
State VA
ZIP 23662-2112
Accounting period End 12
Primary contact name LINDSEY A CARNEY ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DENNIS DALHEIM
TREASURER
254 CEDAR ROAD
POQUOSON VA 23662-2112

Officer/Director/Trustee Two

TAYLOR LAWSON
CHAIRMAN
1111 RIVERSIDE DRIVE
NEWPORT NEWS VA 23606-3614

Officer/Director/Trustee Three

DWIGHT WOLF
SECRETARY
1113 PATRICK LANE
NEWPORT NEWS VA 23608-3156

Officer/Director/Trustee Four

SYDNEY GALOOZIS
DIRECTOR
4119 WILLIAM STYRON SQUARE NORTH
NEWPORT NEWS VA 23606-2870

Officer/Director/Trustee Five

LAUREN SIMONE
DIRECTOR
1211 WESTMORELAND AVENUE
NORFOLK VA 23508-1318

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/10/2020
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TAYLOR LAWSON
Signature Title CHAIRMAN
Signature Date 4/5/2021

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