FORM 1023-EZ for JEFFERSON COUNTY 4-H FOUNDATION

Field Data
EIN 46-4089855
Case Number EO-2015264-000250
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JEFFERSON COUNTY 4-H FOUNDATION
Organization’s Mailing Address 300 JEFFERSON STREET
City OSKALOOSA
State KS
ZIP 66066-0326
Accounting period End 12
Primary contact name BILL MANVILLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRIAN ADAMS
PRESIDENT
5343 86TH STREET
MERIDAN KS 66512

Officer/Director/Trustee Two

SUSAN PATTON
SECRETARY
19035 54TH STREET
MCLOUTH KS 66054

Officer/Director/Trustee Three

ANTOINETTE REEVES
TREASURER
15103 BLUE MOUND RD
VALLEY FALLS KS 66088

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/7/2013
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O52 - Youth Development - Agricultural
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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
Signature Title
Signature Date

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