FORM 1023-EZ for ADVENTURES OF BACKWOODS BROCK & THEA-TEAM

Field Data
EIN 83-0868662
Case Number EO-2018323-000435
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ADVENTURES OF BACKWOODS BROCK & THEA-TEAM
Organization’s Mailing Address 20 W HAWLEY ST
City AMBOY
State IL
ZIP 61310
Accounting period End 12
Primary contact name BROCK DECKER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BROCK DECKER
PRESIDENT
20 W HAWLEY ST
AMBOY IL 61310

Officer/Director/Trustee Two

BRYAN HEATHER
VICE PRESIDENT
7928 EDGEWOOD RD
DIXON IL 61021

Officer/Director/Trustee Three

NATHAN MOORE
SEO
204 S LOCUST ST
SUBLETTE IL 61367

Officer/Director/Trustee Four

AMBER DECKER
SECRETARY
20 W HAWLEY ST
AMBOY IL 61310

Officer/Director/Trustee Five

JORDEN LAHMAN
OFFICER
136 N JONES
AMBOY IL 61310

Organization’s website
Organization’s email ADVENTURESOFBACKWOODSBROCK@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/22/18
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: Yes
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 No
Correctness Declaration Yes
Signature Name AMBER DECKER
Signature Title SECRETARY
Signature Date 11/15/18

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