FORM 1023-EZ for TRI COUNTY COMMUNITY CLUB

Field Data
EIN 86-1608323
Case Number EO-2021082-001025
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TRI COUNTY COMMUNITY CLUB
Organization’s Mailing Address PO BOX 1022
City DURANT
State IA
ZIP 52747
Accounting period End 12
Primary contact name HOLLIE SWAIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERESA KELLER
PRESIDENT/DIRECTOR
2032 W 59TH ST
DAVENPORT IA 52806-1777

Officer/Director/Trustee Two

LESA KEPHART
TREASURER/DIRECTOR
2053 WASHINGTON AVE
WILTON IA 52778-9240

Officer/Director/Trustee Three

JANET GEHRLS
SECRETARY/DIRECTOR
1626 YANKEE AVE
NEW LIBERTY IA 52765-9302

Officer/Director/Trustee Four

HOLLIE SWAIN
VICE-PRESIDENT/DIRECTOR
611 WISCONSIN AVE
DAVENPORT IA 52804-4715

Officer/Director/Trustee Five

DAWN SMITH
DIRECTOR
211 BROOKVIEW
DURANT IA 52747-0727

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2021
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N50 - Recreational, Pleasure, or Social Club
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 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 HOLLIE SWAIN
Signature Title VICE-PRESIDENT/DIRECTOR
Signature Date 2/1/2021

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