FORM 1023-EZ for THE CODY VAUGHN DERRICK FOUNDATION

Field Data
EIN 47-3685501
Case Number EO-2015106-000273
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE CODY VAUGHN DERRICK FOUNDATION
Organization’s Mailing Address 839 E SOUTH TEMPLE
City SALT LAKE CITY
State UT
ZIP 84102
Accounting period End 12
Primary contact name CODY DERRICK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CODY DERRICK
PRESIDENT, DIRECTOR
839 E SOUTH TEMPLE
SALT LAKE CITY UT 84102

Officer/Director/Trustee Two

TERESSA TOOMBS
SECRETARY, DIRECTOR
876 E VINE ST
MURRAY UT 84107

Officer/Director/Trustee Three

LEIGH BERNAL
TREASURER, DIRECTOR
846 E GARFIELD AVE
SALT LAKE CITY UT 84105

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/18/2015
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
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
Signature Title
Signature Date

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