FORM 1023-EZ for GAME-FIT MIND AND BODY YOUTH SERVICES

Field Data
EIN 47-2759344
Case Number EO-2015091-000283
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GAME-FIT MIND AND BODY YOUTH SERVICES
Organization’s Mailing Address 1201 DEL PASO BLVD
City SACRAMENTO
State CA
ZIP 95815-3644
Accounting period End 12
Primary contact name THOMAS W BURRUSS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRIANA ADAMS
CHAIR
2206 GOLD CIRCLE
ROCKLIN CA 95765-4357

Officer/Director/Trustee Two

MOLLY IBIETATORREMENDIA
TREASURER
2401 SERENATA COURT
SACRAMENTO CA 95835-1313

Officer/Director/Trustee Three

RICHARD JOHNSON
SECRETARY
5350 JACKSON STREET 134
NORTH HIGHLANDS CA 95660-6325

Officer/Director/Trustee Four

DREZELLE CAIN
DIRECTOR
7024 21ST STREET
SACRAMENTO CA 95822-4309

Organization’s website WWW.GAME-FIT.COM
Organization’s email INFO@GAME-FIT.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/5/2015
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O54 - Youth Development - Citizenship Programs
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: No
Amateur Sports: Yes
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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