FORM 1023-EZ for GYM FOUNDATION

Field Data
EIN 27-2302251
Case Number EO-2015197-000324
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GYM FOUNDATION
Organization’s Mailing Address 14000 FLOYD STREET SUITE A
City UPPER MARLBORO
State MD
ZIP 20772
Accounting period End 12
Primary contact name MIKE ANDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MIKE ANDERSON
PRESIDENT EXECUTIVE DIRECTOR
14000 FLOYD ST
UPPER MARLBORO MD 20772

Officer/Director/Trustee Two

TONYA ANDERSON
V.P TREASURER
14000 FLOYD STREET
UPPER MARLBORO MD 20772

Officer/Director/Trustee Three

CASANDRA DAVIS PERRILLIAT
V.P. PROGRAM DIRECTOR
9209 LORTON VALLEY ROAD
LORTON VA 22079

Officer/Director/Trustee Four

TANGIE GOLSTON
V.P. SECRETARY
19347 CIRCLE GATE DRIVE SUITE 304
GERMANTOWN MD 20874

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/24/2010
Organization Incorporation State MD
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: No
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 Yes
Donation of funds Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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