FORM 1023-EZ for ROOTED YOUTH MINISTRY

Field Data
EIN 81-4542908
Case Number EO-2017031-000218
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROOTED YOUTH MINISTRY
Organization’s Mailing Address 107 SW 1ST STREET SUITE 102
City ENTERPRISE
State OR
ZIP 97828
Accounting period End 12
Primary contact name TINA HITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID HITE
PRESIDENT
401 MONTCLAIR STREET
ENTERPRISE OR 97828

Officer/Director/Trustee Two

KRISTINA HITE
SECRETARY/TREASURER
401 MONTCLAIR STREET
ENTERPRISE OR 97828

Officer/Director/Trustee Three

JUSTIN PETERS
DIRECTOR
210 1/2 S RIVER ST
ENTERPRISE OR 97828

Officer/Director/Trustee Four

SHARAN NEWELL
DIRECTOR
104 W GREENWOOD ST
ENTERPRISE OR 97828

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/29/2016
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
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 Yes
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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