FORM 1023-EZ for CITY AND COUNTY YOUTH INCORPORATED

Field Data
EIN 82-4138650
Case Number EO-2018047-000212
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CITY AND COUNTY YOUTH INCORPORATED
Organization’s Mailing Address 607 SHIVERS STREET
City BLYTHEVILLE
State AR
ZIP 72315
Accounting period End 12
Primary contact name SHANNON SIMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RANDY HENDERSON
CHAIRMAN
527 LAURA
GOSNELL AR 72315

Officer/Director/Trustee Two

KENNY JACKSON
VICE-CHAIRMAN
PO BOX 296
DELL AR 72426

Officer/Director/Trustee Three

SHANNON SIMS
EXECUTIVE DIRECTOR
607 SHIVERS STREET
BLYTHEVILLE AR 72315

Officer/Director/Trustee Four

MELISA LOGAN
SECRETARY/TREASURER
313 SCOTT STREET
BLYTHEVILLE AR 72315

Officer/Director/Trustee Five

RICKY SIMS
MEMBER
909 PIERCE
BLYTHEVILLE AR 72315

Organization’s website
Organization’s email DUCKSIMS607@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/24/18
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SHANNON SIMS
Signature Title EXECUTIVE DIRECTOR
Signature Date 2/14/18

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