FORM 1023-EZ for JACOBS LADDER FOR YOUTH

Field Data
EIN 61-1729480
Case Number EO-2016216-000115
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JACOBS LADDER FOR YOUTH
Organization’s Mailing Address PO BOX 480855
City KANSAS CITY
State MO
ZIP 64148
Accounting period End 12
Primary contact name MICHAEL COZART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERENCE SMITH
PRESIDENT/CEO
405 E 111TH TERR
KANSAS CITY MO 64134

Officer/Director/Trustee Two

LISA STEWART
SECRETARY
5904 BRITTANY
MERRIAM KS 66203

Officer/Director/Trustee Three

MARCUS WILLIAMS
BOARD MEMBER
1601 E 18TH STREET STE 200L
KANSAS CITY MO 64108

Officer/Director/Trustee Four

ANDRE RELIFORD
BOARD MEMBER
1614 COLT CIRCLE
RAYMORE MO 64083

Officer/Director/Trustee Five

FLOYD WILSON
BOARD MEMBER
13325 CRYSTAL AVENUE
GRANDVIEW MO 64030

Organization’s website N/A
Organization’s email SMTH_TRNC@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/14/2004
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O99 - Youth Development N.E.C.
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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