FORM 1023-EZ for MALCOLM YOUTH SPORTS ASSOCIATION

Field Data
EIN 26-1128729
Case Number EO-2015245-000344
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MALCOLM YOUTH SPORTS ASSOCIATION
Organization’s Mailing Address 10004 NW 112TH ST
City MALCOLM
State NE
ZIP 68402-9561
Accounting period End 12
Primary contact name TINA DENTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT KOUMA
PRESIDENT
241 ELK CREEK
MALCOLM NE 68402

Officer/Director/Trustee Two

REGGIE SALTZMAN
SECRETARY
6655 NW 105TH
MALCOLM NE 68402

Officer/Director/Trustee Three

TINA DENTON
VICE PRESIDENT
11801 TRAILS END
LINCOLN NE 68524

Officer/Director/Trustee Four

DAMON SALTZMAN
TREASURER
6655 NW 105TH
MALCOLM NE 68402

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/30/2007
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O23 - Boys and Girls Clubs (Combined)
Organization’s purpose Charitable: No
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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