FORM 1023-EZ for COMMUNITY CHRISTIAN YOUTH CENTER OFFORT DODGE

Field Data
EIN 47-5240160
Case Number EO-2015281-000346
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COMMUNITY CHRISTIAN YOUTH CENTER OFFORT DODGE
Organization’s Mailing Address 125 N 27TH STREET
City FORT DODGE
State IA
ZIP 50501
Accounting period End 12
Primary contact name CALEB CARLSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAVID GRINDBERG
DIRECTOR
239 N 11TH STREET
FORT DODGE IA 50501

Officer/Director/Trustee Two

CLARICE THOMPSON
DIRECTOR
3318 5TH AVENUE S
FORT DODGE IA 50501

Officer/Director/Trustee Three

BETTY MCNEIL
DIRECTOR
1611 WILLIAMS DRIVE
FORT DODGE IA 50501

Officer/Director/Trustee Four

RICHARD GRAVES
DIRECTOR
1007 S 10TH STREET
FORT DODGE IA 50501

Officer/Director/Trustee Five

CALEB CARLSON
EXECUTIVE DIRECTOR
1111 5TH AVENUE N
FORT DODGE IA 50501

Organization’s website WWW.FACEBOOK.COM/PAGES/ICKYS-YOUTH-CENTER/1429339140661524
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/9/2015
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
Organization’s purpose Charitable: No
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
Signature Title
Signature Date

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