FORM 1023-EZ for KNOX COUNTY LOCAL CANCER FUND INC

Field Data
EIN 47-1658863
Case Number EO-2014237-000233
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KNOX COUNTY LOCAL CANCER FUND INC
Organization’s Mailing Address 207 N FIRST ST
City EDINA
State MO
ZIP 63537
Accounting period End 12
Primary contact name BOBBI D CLARK CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KYANE MARBLE
CHAIRPERSON
205 N FULTON ST
EDINA MO 63537

Officer/Director/Trustee Two

KARISHA DEVLIN
VICE CHAIRPERSON
61256 REGAL AVE
EDINA MO 63537

Officer/Director/Trustee Three

LORI MOOTS-CLAIR
SECRETARY
53543 DANDY PLACE
EDINA MO 63537

Officer/Director/Trustee Four

BOBBI CLARK
TREASURER
53090 CEDAR LP
EDINA MO 63537

Officer/Director/Trustee Five

COURTNEY BONNELL
FUNDRAISING COORDINATOR
51623 STATE HWY P
EDINA MO 63537

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/22/2014
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T12 - Fund Raising and/or Fund 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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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