FORM 1023-EZ for NC CAROLINA VENOM

Field Data
EIN 83-1876774
Case Number EO-2018346-000354
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NC CAROLINA VENOM
Organization’s Mailing Address 615 HUNLEY ST
City MONROE
State NC
ZIP 28112-6521
Accounting period End 12
Primary contact name LATISHA WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LATISHA WILLIAMS
ADMINISTRATIVE ASSISTANT
615 HUNLEY ST
MONROE NC 28112-6521

Officer/Director/Trustee Two

LAMEEN WILLIAMS
CEO
615 HUNLEY ST
MONROE NC 28112-6521

Officer/Director/Trustee Three

CLIFF PROVIDENCE
CO-OWNER
9230 PERSEVERANCE DR
HARRISBURG NC 28075-8396

Officer/Director/Trustee Four

ERIC PATTERSON
CO-OWNER
12845 MEADOW CREEK LN APT 201
PINEVILLE NC 28134-5320

Officer/Director/Trustee Five

JENNIFER THOMAS
CFO
6100 FLAGSTONE LANE APT 204
INDIAN TRAIL NC 28079

Organization’s website
Organization’s email CAROLINAVENOMSEMIPROFOOTBALL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/28/18
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N65 - Football Clubs, Leagues
Organization’s purpose Charitable: No
Religious: No
Educational: No
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 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 LATISHA WILLIAMS
Signature Title ADMINISTRATIVE ASSISTANT
Signature Date 12/10/18

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