FORM 1023-EZ for JHB STUDENT ATHLETE FUND INC

Field Data
EIN 27-2978149
Case Number EO-2014363-000043
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JHB STUDENT ATHLETE FUND INC
Organization’s Mailing Address 18 GRIST MILL ROAD
City GLASTONBURY
State CT
ZIP 06033-2542
Accounting period End 12
Primary contact name COURTNEY LARKIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

COURTNEY B LARKIN
CO-PRESIDENT
18 GRIST MILL ROAD
GLASTONBURY CT 06033

Officer/Director/Trustee Two

JOHN D BLAIR
CO-PRESIDENT
170 FALCON RIDGE ROAD
ROCKY HILL CT 06067

Officer/Director/Trustee Three

H CRAIG LEROY
SECRETARY
2 CARNOUSTIE CIRCLE
BLOOMFIELD CT 06002

Officer/Director/Trustee Four

SEAN COLLINS
DIRECTOR
13275 BETHANY ROAD
ALPHARETTA GA 30009

Officer/Director/Trustee Five

ROBERT KEHMNA
DIRECTOR
67 CORNERSTONE DRIVE
SOUTH WINDSOR CT 06074

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/18/2010
Organization Incorporation State CT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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