FORM 1023-EZ for TEAM KHAOS INC

Field Data
EIN 84-4105857
Case Number EO-2020006-000303
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TEAM KHAOS INC
Organization’s Mailing Address 569 CODY CALEB DR
City WINTER HAVEN
State FL
ZIP 33884
Accounting period End 12
Primary contact name CHRISTOPHER DESROCHERS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEROME RICHARDSON
PRESIDENT AND DIRECTOR
569 CODY CALEB DR
WINTER HAVEN FL 33884

Officer/Director/Trustee Two

CLAIR ENGLEBREHT
SECRETARY AND DIRECTOR
100 LK REGION BLVD N
WINTER HAVEN FL 33881

Officer/Director/Trustee Three

BRIANNE POTZ
TREASURER AND DIRECTOR
1422 MORNINGSIDE DR
LK WALES FL 33853

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/17/2019
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
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 JEROME RICHARDSON
Signature Title PRESIDENT AND DIRECTOR
Signature Date 1/2/2020

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