FORM 1023-EZ for DOUGLAS KNM GYMNASTICS BOOSTER CLUB

Field Data
EIN 83-1143529
Case Number EO-2018190-000595
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DOUGLAS KNM GYMNASTICS BOOSTER CLUB
Organization’s Mailing Address 9 CHAPPARAL
City DOUGLAS
State WY
ZIP 82633
Accounting period End 9
Primary contact name MICHELE GOFF
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER ADELMAN-EMBREY
PRESIDENT
620 C NORTH WINDRIVER DR
DOUGLAS WY 82633

Officer/Director/Trustee Two

CASSANDRA VAILLETTE
SECRETARY
401 S RUSSELL AVE LOT 142
DOUGLAS WY 82633

Officer/Director/Trustee Three

MICHELE GOFF
TREASURER
9 CHAPPARAL
DOUGLAS WY 82633

Officer/Director/Trustee Four

LISA WILLIAMS
VICE PRESIDENT
1122 GREEN RIVER RD
DOUGLAS WY 82633

Organization’s website
Organization’s email BOOSTERKNM@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/6/18
Organization Incorporation State WY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
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 Yes
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MICHELE GOFF
Signature Title TREASURER
Signature Date 7/6/18

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