FORM 1023-EZ for MV MAVERICKS

Field Data
EIN 45-5629742
Case Number EO-2017193-000265
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MV MAVERICKS
Organization’s Mailing Address 1800 BRIARWOOD DR
City MOUNT VERNON
State IL
ZIP 62864
Accounting period End 12
Primary contact name ROSS ZINZILIETA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RAYMOND CLODI
PRESIDENT
1800 BRIARWOOD DR
MOUNT VERNON IL 62864

Officer/Director/Trustee Two

DAVID MESTEL
VICE PRESIDENT
10221 EAST GARDEN RD
MOUNT VERNON IL 62864

Officer/Director/Trustee Three

BRADLEY HAYS
SECRETARY
5100 APPLE RIDGE RD
SALEM IL 62881

Officer/Director/Trustee Four

KIMBERLY LIVESAY
DIRECTOR
23080 REMINGTON RD
MACEDONIA IL 62860

Officer/Director/Trustee Five

DONNA WOOD
DIRECTOR
809 NORTH 27TH ST
MOUNT VERNON IL 62864

Organization’s website NA
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/7/2017
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N72 - Special Olympics
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 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
Signature Title
Signature Date

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