FORM 1023-EZ for ADOPT A CHILD PROGRAM

Field Data
EIN 84-3575746
Case Number EO-2019310-000211
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ADOPT A CHILD PROGRAM
Organization’s Mailing Address 401 N FRANKLIN ST
City KIRKSVILLE
State MO
ZIP 63501
Accounting period End 12
Primary contact name TERESA ATTEBERY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERESA ATTEBERY
PROGRAM DIRECTOR
401 N FRANKLIN ST
KIRKSVILLE MO 63501

Officer/Director/Trustee Two

JON COOK
ASSISTANT DIRECTOR
401 N FRANKLIN ST
KIRKSVILLE MO 63501

Officer/Director/Trustee Three

STEVE LLOYD
COMMITTEE MEMBER
401 N FRANKLIN ST
KIRKSVILLE MO 63501

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/19
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P58 - Gift Distribution
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TERESA ATTEBERY
Signature Title PROGRAM DIRECTOR
Signature Date 11/4/19

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