FORM 1023-EZ for TEAM USA GEORGIA INC

Field Data
EIN 26-3858079
Case Number EO-2018346-000320
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TEAM USA GEORGIA INC
Organization’s Mailing Address 379 MATHIS DRIVE
City ROME
State GA
ZIP 30165
Accounting period End 12
Primary contact name JAY STEPHENSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAY STEPHENSON
CEO
304 DODD STREET
ROME GA 30165

Officer/Director/Trustee Two

POWELL FULTON
TREAUSURER
208 GREENVIEW DRIVE
ROME GA 30165

Officer/Director/Trustee Three

KARMEN STEPHENSON
SECRETARY
304 DODD STREET
ROME GA 30165

Officer/Director/Trustee Four

KEVIN FITZSIMMONS
FUNDRAISING
104 NORTHWOOD DRIVE NE
ROME GA 30161

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/10/08
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N70 - Amateur Sports Competitions
Organization’s purpose Charitable: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JAY STEPHENSON
Signature Title CEO
Signature Date 12/10/18

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