FORM 1023-EZ for BEDROCK YOUTH INC

Field Data
EIN 85-2496773
Case Number EO-2020232-000009
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BEDROCK YOUTH INC
Organization’s Mailing Address 2920 INDIANA AVE
City FORT WAYNE
State IN
ZIP 46803
Accounting period End 12
Primary contact name CAMERON SHACKLEFORD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GORDON MARTIN
CEO AND DIRECTOR
2920 INDIANA AVE
FORT WAYNE IN 46807

Officer/Director/Trustee Two

ARTHUR WILSON
CHAIRMAN/DIRECTOR
2920 INDIANA AVE
FORT WAYNE IN 46807

Officer/Director/Trustee Three

MARGARET JORDAN
TREASURER
1001 POINTE CTR CV
FORT WAYNE IN 46819

Officer/Director/Trustee Four

DONNA MASTERSON
DIRECTOR
4330 BUELL DR
FORT WAYNE IN 46807

Officer/Director/Trustee Five

VIRGIL THARP
DIRECTOR
2920 INDIANA AVE
FORT WAYNE IN 46807

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/11/2020
Organization Incorporation State IN
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: 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 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 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 MARGARET JORDAN
Signature Title TREASURER
Signature Date 8/17/2020

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