FORM 1023-EZ for CLOWNS CHANGING HAITI INC

Field Data
EIN 81-1040882
Case Number EO-2016026-000068
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLOWNS CHANGING HAITI INC
Organization’s Mailing Address 1023 E PORTLAND
City SPRINGFIELD
State MO
ZIP 65807
Accounting period End 12
Primary contact name BOB GARDNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BOB GARDNER
PRESIDENT, SECRETARY
1023 E PORTLAND
SPRINGFIELD MO 65807

Officer/Director/Trustee Two

AMY BRICKMAN
VICE PRESIDENT, TREASURER
580 N BROADVIEW CT
COLUMBIA MO 65201

Officer/Director/Trustee Three

KAMILLE SCHULTZ
DIRECTOR
3523 INVERNESS CT
SPRINGFIELD MO 65809

Officer/Director/Trustee Four

LEAH CAPPS
DIRECTOR
5616 N 11TH AVE
OZARK MO 65721

Officer/Director/Trustee Five

JOAN REED
DIRECTOR
21 N CEDAR LAKE DR W
OZARK MO 65203

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/24/2015
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A90 - Arts Service Organizations and Activities
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 Yes
Conducting Activities Outside of United States Yes
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
Signature Title
Signature Date

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