FORM 1023-EZ for COFFEE COUNTY QUARTERBACK CLUB

Field Data
EIN 84-2786260
Case Number EO-2019248-000177
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COFFEE COUNTY QUARTERBACK CLUB
Organization’s Mailing Address 3038
City MANCHESTER
State TN
ZIP 37355
Accounting period End 6
Primary contact name ROBERT GILLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT GILLEY
PRESIDENT
4905 MURFREESBORO HWY
MANCHESTER TN 37355

Officer/Director/Trustee Two

JOHNNY MARTIN
VICE PRESIDENT
158 LARIAT LANE
MANCHESTER TN 37355

Officer/Director/Trustee Three

AMY MARTIN
SECRETARY
158 LARIAT LANE
MANCHESTER TN 37355

Officer/Director/Trustee Four

BRANDI HARMON
TREASURER
328 BLACKBERRY LANE
MANCHESTER TN 37355

Organization’s website
Organization’s email CCQBCLUB@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/3/19
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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 ROBERT GILLEY
Signature Title PRESIDENT
Signature Date 9/3/19

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