FORM 1023-EZ for THE TEN21 FOUNDATION

Field Data
EIN 83-4331920
Case Number EO-2019107-000233
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE TEN21 FOUNDATION
Organization’s Mailing Address 11713 S LOCUST AVE
City JENKS
State OK
ZIP 74037
Accounting period End 12
Primary contact name TIMOTHY LABELLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TIMOTHY LABELLE
DIRECTOR
11713 S LOCUST AVE
Jenks OK 74037

Officer/Director/Trustee Two

THOMAS BROOKHART
INCORPORATOR
10510 S 69TH EAST AVE
JENKS OK 74133

Officer/Director/Trustee Three

DAVID WAITS
INCORPORATOR
1406 WEST PITTSBURG PLACE
BROKEN ARROW OK 74012

Organization’s website
Organization’s email TEN21FOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/19
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: No
Amateur Sports: Yes
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
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 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 TIMOTHY LABELLE
Signature Title DIRECTOR
Signature Date 4/15/19

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