FORM 1023-EZ for PUTTING ATHLETES AND COMMUNITY TOGETHER

Field Data
EIN 82-2133373
Case Number EO-2018093-000055
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PUTTING ATHLETES AND COMMUNITY TOGETHER
Organization’s Mailing Address PO BOX 4204
City WOODBRIDGE
State VA
ZIP 22194
Accounting period End 12
Primary contact name LAVONDA WORTHAM - CO-CHAIR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GARY WORTHAM JR
EXECUTIVE DIRECTOR
PO BOX 4204
WOODBRIDGE VA 22194

Officer/Director/Trustee Two

GARY WORTHAM SR
CHAIRMAN
PO BOX 4204
WOODBRIDGE VA 22194

Officer/Director/Trustee Three

LAVONDA WORTHAM
CO-CHAIR
PO BOX 4204
WOODBRIDGE VA 22194

Officer/Director/Trustee Four

JULIA MADISON
TREASURER
PO BOX 4204
WOODBRIDGE VA 22194

Officer/Director/Trustee Five

ANESA STROY
SECRETARY
PO BOX 4204
WOODBRIDGE VA 22194

Organization’s website WWW.GOPACT.ORG
Organization’s email GOPACT.ORG@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/6/17
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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 GARY WORTHAM JR
Signature Title EXECUTIVE DIRECTOR
Signature Date 4/1/18

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