FORM 1023-EZ for JEFFERSON PARK FORWARD

Field Data
EIN 81-1946774
Case Number EO-2016224-000546
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JEFFERSON PARK FORWARD
Organization’s Mailing Address 5414 N LUNA AVE
City CHICAGO
State IL
ZIP 60630-1310
Accounting period End 9
Primary contact name DOUGLAS GROM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RYAN RICHTER
PRESIDENT
5414 N LUNA AVE
CHICAGO IL 60630-1310

Officer/Director/Trustee Two

ROBERT VAN HOOK
TREASURER
5414 N LUNA AVE
CHICAGO IL 60630-1310

Officer/Director/Trustee Three

ROLANDO RODRIGUEZ
VICE PRESIDENT
5414 N LUNA AVE
CHICAGO IL 60630-1310

Officer/Director/Trustee Four

MARIE MACDONALD
SECRETARY
5414 N LUNA AVE
CHICAGO IL 60630-1310

Officer/Director/Trustee Five

DOUGLAS GROM
DIRECTOR
5414 N LUNA AVE
CHICAGO IL 60630-1310

Organization’s website WWW.JEFFERSONPARKFORWARD.ORG
Organization’s email WEBMASTER@JEFFERSONPARKFORWARD.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/23/2016
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S22 - Neighborhood, Block Associations
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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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