FORM 1023-EZ for SOUTHSIDE STORM YOUTH LACROSSE

Field Data
EIN 82-2569622
Case Number EO-2017237-000155
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTHSIDE STORM YOUTH LACROSSE
Organization’s Mailing Address 7642 W 157TH PLACE
City ORLAND PARK
State IL
ZIP 60462
Accounting period End 8
Primary contact name RYAN PISARIK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RYAN PISARIK
DIRECTOR
7642 W 157TH PLACE
ORLAND PARK IL 60462

Officer/Director/Trustee Two

KATHRYN JABLECKI
DIRECTOR
11663 GLENVIEW DR
ORLAND PARK IL 60467

Officer/Director/Trustee Three

MELISSA FOUNTAIN
DIRECTOR
17652 CRESTVIEW COURT
ORLAND PARK IL 60467

Officer/Director/Trustee Four

MARCUS MCKIBBEN
DIRECTOR
8165 BRAEBURN LANE
ORLAND PARK IL 60462

Officer/Director/Trustee Five

JORGE MONTALVO
DIRECTOR
9614 W WILLOW LANE
MOKENA IL 60448

Organization’s website WWW.SOUTHSIDESTORMLAX.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/23/2017
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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 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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