FORM 1023-EZ for PLANT-BASED GREEN COUNTRY ORGANIZATION

Field Data
EIN 83-0872063
Case Number EO-2018169-000337
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PLANT-BASED GREEN COUNTRY ORGANIZATION
Organization’s Mailing Address 10710 S HOLLEY ST
City JENKS
State OK
ZIP 74037
Accounting period End 12
Primary contact name MELISSA ANNE FURMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MELISSA FURMAN
PRESIDENT
10710 S HOLLEY ST
JENKS OK 74037

Officer/Director/Trustee Two

KRISANN POLITO-MOLLER
VICE PRESIDENT
10710 S HOLLEY ST
JENKS OK 74037

Officer/Director/Trustee Three

DAWNELLE TUCKER
TREASURER
10710 S HOLLEY ST
JENKS OK 74037

Officer/Director/Trustee Four

KELLY FLESNER-GURLEY
SECRETARY
10710 S HOLLEY ST
JENKS OK 74037

Officer/Director/Trustee Five

BRENT BEASLEY
MEMBER AT LARGE
10710 S HOLLEY ST
JENKS OK 74037

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/8/18
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K40 - Nutrition Programs
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 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 MELISSA FURMAN
Signature Title PRESIDENT
Signature Date 6/13/18

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