FORM 1023-EZ for WATER POLO CLUB AT NCSU

Field Data
EIN 56-2236356
Case Number EO-2018016-000559
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WATER POLO CLUB AT NCSU
Organization’s Mailing Address C/O INTRAMURAL OFC NCSU BOX 8111
City RALEIGH
State NC
ZIP 27695-1
Accounting period End 12
Primary contact name PATRICIA CATES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ZACHARY SHUROW
PRESIDENT
1120 CLARION HEIGHTS LN
RALEIGH NC 27606

Officer/Director/Trustee Two

RICHARD CATES III
VICE PRESIDENT
203 WILTSHIRE DR
JAMESTOWN NC 27282

Officer/Director/Trustee Three

ANNA REHDER
TREASURER
1303 LORIMER ROAD
RALEIGH NC 27606

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/1/14
Organization Incorporation State NC
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: 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 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 RICHARD CATES III
Signature Title VICE PRESIDENT
Signature Date 1/13/18

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