FORM 1023-EZ for BURDICK YOUTH INITIATIVE INC

Field Data
EIN 84-4252700
Case Number EO-2020014-000116
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BURDICK YOUTH INITIATIVE INC
Organization’s Mailing Address 4100
City WESTON
State FL
ZIP 33331
Accounting period End 12
Primary contact name LORI DACOSSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LORI DACOSSE
DIRECTOR
4100 AMBER LANE
WESTON FL 33331

Officer/Director/Trustee Two

RONALD BURDICK
DIRECTOR
12 BUENA VISTA DR
MURPHYSBORO IL 62966

Officer/Director/Trustee Three

MITCHELL BURDICK
DIRECTOR
21 WESTWOOD LANE
MURPHYSBORO IL 62966

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/20/2019
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LORI DACOSSE
Signature Title DIRECTOR
Signature Date 1/12/2020

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