FORM 1023-EZ for COMMUNITY YOUTH CENTER INC

Field Data
EIN 38-4092246
Case Number EO-2018302-000580
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY YOUTH CENTER INC
Organization’s Mailing Address 3 W MAIN STREET
City FLORA
State IN
ZIP 46929
Accounting period End 12
Primary contact name PAUL VELDHUIZEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PAUL VELDHUIZEN
EXECUTIVE DIRECTOR
3250 W 700 N
DELPHI IN 46923

Officer/Director/Trustee Two

MICHAEL ROGERS
PRESIDENT
310 N WASHINGTON STREET
FLORA IN 46929

Officer/Director/Trustee Three

NICHOLE BOUSUM
TREASURER
9234 HIGH STREET
CLARKS HILL IN 47930

Officer/Director/Trustee Four

ADAM BRIDGE
SECRETARY
305 N WASHINGTON STREET
FLORA IN 46929

Officer/Director/Trustee Five

LYSSA WILSON
DIRECTOR
2856 E 250 S
BRINGHURST IN 46929

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/16/18
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O55 - Youth Development - Religious Leadership
Organization’s purpose Charitable: Yes
Religious: Yes
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 PAUL VELDHUIZEN
Signature Title EXECUTIVE DIRECTOR
Signature Date 10/27/18

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