FORM 1023-EZ for THE PAVILION CLUBHOUSE OF ROUND ROCK

Field Data
EIN 82-0704511
Case Number EO-2017075-000502
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE PAVILION CLUBHOUSE OF ROUND ROCK
Organization’s Mailing Address 4010 SAM BASS
City ROUND ROCK
State TX
ZIP 78681-1569
Accounting period End 3
Primary contact name GORDON BUTLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LEE BERGERON
CHAIRMAN
4010 SAM BASS
ROUND ROCK TX 78681-1569

Officer/Director/Trustee Two

JERRY BLIZZARD
TREASURER
4010 SAM BASS
ROUND ROCK TX 78681-1569

Officer/Director/Trustee Three

TRAVIS BLACK
SECRETARY
4010 SAM BASS
ROUND ROCK TX 78681-1569

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/28/2017
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F30 - Mental Health Treatment - Multipurpose and N.E.C.
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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