FORM 1023-EZ for K S J B YOUTH INC

Field Data
EIN 83-1262975
Case Number EO-2019234-000330
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name K S J B YOUTH INC
Organization’s Mailing Address 8106 PAGODA DRIVE
City SPRING HILL
State FL
ZIP 34606
Accounting period End 12
Primary contact name HORACE BAILEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KIMBERLY KINCADE
PRESIDENT
8106 PAGODA DRIVE
SPRING HILL FL 34606

Officer/Director/Trustee Two

SHERRI COLLINS
VIC PRESIDENT
11169 ELGIN BLVD
SPRING HILL FL 34608

Officer/Director/Trustee Three

HORACE BAILEY
TREASURE
1916 CRYSTAL GROVE DR
LAKELAND FL 33801

Officer/Director/Trustee Four

KEAVIN MOSS
SECRETARY
2123 HAWTHORNE
SPRING HILL FL 33609

Officer/Director/Trustee Five

KATHERINE VEGA
DIRECTOR
18210 MERWYN CIRCLE
WEEKI WACHEE FL 34614

Organization’s website
Organization’s email HBJGIE@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/6/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N65 - Football Clubs, Leagues
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: No
Amateur Sports: Yes
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 HORACE BAILEY
Signature Title TREASURE
Signature Date 8/20/19

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