FORM 1023-EZ for NORTH BROAD YOUTH CENTER INC

Field Data
EIN 47-4204876
Case Number EO-2015161-000472
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NORTH BROAD YOUTH CENTER INC
Organization’s Mailing Address 1148 NORTH BROAD STREET
City ROME
State GA
ZIP 30161
Accounting period End 12
Primary contact name F RENE FOUNTAIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

F RENE FOUNTAIN
CHAIRMAN
35 COVEY RISE DR SE
ROME GA 30161

Officer/Director/Trustee Two

GARY GRAVES
DIRECTOR
2171 BURNETT FERRY RD
ROME GA 30165

Officer/Director/Trustee Three

JOHN MAYES
DIRECTOR
7575 NEW CALHOUN HWY
ADAIRSVILLE GA 30103

Officer/Director/Trustee Four

WALT BUSBY
DIRECTOR
891 COUNTY ROAD 707
CEDAR BLUFF AL 35959

Officer/Director/Trustee Five

KEVIN FOUNTAIN
DIRECTOR
35 COVEY RISE DR SE
ROME GA 30161

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/5/2015
Organization Incorporation State GA
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 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
Signature Title
Signature Date

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