FORM 1023-EZ for FB CLUBHOUSE

Field Data
EIN 82-1331272
Case Number EO-2017172-000247
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FB CLUBHOUSE
Organization’s Mailing Address 2718 BRIGHT TRAIL
City SUGAR LAND
State TX
ZIP 77479
Accounting period End 12
Primary contact name KENNETH SUMNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KENNETH SUMNER
DIRECTOR
2718 BRIGHT TRAIL
SUGAR LAND TX 77479

Officer/Director/Trustee Two

PATRICIA SUMNER
DIRECTOR
2718 BRIGHT TRAIL
SUGAR LAND TX 77479

Officer/Director/Trustee Three

JOHN ROBSON
DIRECTOR
21934 RIVERGATE COURT
RICHMOND TX 77469

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/9/2017
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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