FORM 1023-EZ for DEPOT - JORDAN VALLEY TEEN CENTER

Field Data
EIN 36-4812633
Case Number EO-2019246-000245
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DEPOT - JORDAN VALLEY TEEN CENTER
Organization’s Mailing Address PO BOX 283
City EAST JORDAN
State MI
ZIP 49727-283
Accounting period End 12
Primary contact name JENNIFER GRZEBYK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BAILEY KISHEFSKY
PRESIDENT
PO BOX 283
EAST JORDAN MI 49727-283

Officer/Director/Trustee Two

MATT HAMILTON
VICE PRESDIENT
PO BOX 283
EAST JORDAN MI 49727-283

Officer/Director/Trustee Three

JENI WILLINGHAM
SECRETARY
PO BOX 283
EAST JORDAN MI 49727-283

Officer/Director/Trustee Four

JENNIFER GRZEBYK
TREASURER
PO BOX 283
EAST JORDAN MI 49727-283

Officer/Director/Trustee Five

GARY ROBERTS
DIRECTOR
PO BOX 283
EAST JORDAN MI 49727-283

Organization’s website EJDEPOT.ORG
Organization’s email DEPOTJVTEENCENTER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/13/15
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JENNIFER GRZEBYK
Signature Title TREASURER
Signature Date 8/29/19
EIN 36-4812633
Case Number EO-2016033-000169
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE DEPOT JORDAN VALLEY TEEN CENTERINC
Organization’s Mailing Address PO BOX 283
City EAST JORDAN
State MI
ZIP 49727
Accounting period End 12
Primary contact name AIMEE GIBBERT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PATRICK ONEILL
DIRECTOR
05975 MILES RD
EAST JORDAN MI 49727

Officer/Director/Trustee Two

AMY ONEILL
SECRETARY
05975 MILES RD
EAST JORDAN MI 49727

Officer/Director/Trustee Three

BRAD CAREY
DIRECTOR
5413 CARSON RD
EAST JORDAN MI 49727

Officer/Director/Trustee Four

MATT HAMILTON
DIRECTOR
9236 PHELPS RD
EAST JORDAN MI 49727

Officer/Director/Trustee Five

AIMEE GIBBERT
CHAIRPERSON
9273 SUNRISE DR
ELSWORTH MI 49729

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/23/2015
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
Organization’s purpose Charitable: No
Religious: Yes
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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