FORM 1023-EZ for LAKE BUTLER ROTARY CLUB NUMBER 4372

Field Data
EIN 82-1602906
Case Number EO-2017150-000150
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKE BUTLER ROTARY CLUB NUMBER 4372
Organization’s Mailing Address 155 NW 1ST STREET
City LAKE BUTLER
State FL
ZIP 32054
Accounting period End 12
Primary contact name TED M BARBER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STEVEN WELLHAUSEN
PRESIDENT
7819 NW 228 ST
RAIFORD FL 32083

Officer/Director/Trustee Two

TED BARBER
PRESIDENT-ELECT
16768 SE 91ST STREET
LAKE BUTLER FL 32054

Officer/Director/Trustee Three

DONNA HARRIS
SECRETARY
23873 NE SR 16
RAIFORD FL 32083

Officer/Director/Trustee Four

KELLIE CONNELL
TREASURER
7335 SE 194TH PLACE
LAKE BUTLER FL 32054

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/22/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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