FORM 1023-EZ for CCRM1

Field Data
EIN 47-1343723
Case Number EO-2014240-000464
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CCRM1
Organization’s Mailing Address 10 CONCORD AVE
City FORT THOMAS
State KY
ZIP 41075
Accounting period End 12
Primary contact name JERRY WALLACE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JERRY WALLACE
PRESIDENT
10 CONCORD AVE
FORT THOMAS KY 41075

Officer/Director/Trustee Two

BEN IDEN
TREASURER
3291 MCCOWAN DRIVE
TAYLOR MILL KY 41015

Officer/Director/Trustee Three

RON DAVIS
SECRETARY
227 FARMINGTON DRIVE
FORT MITCHELL KY 41017

Organization’s website WWW.CCRMWORKS.ORG
Organization’s email JERRY@CCRMWORKS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/8/2014
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T31 - Community Foundations
Organization’s purpose Charitable: Yes
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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