FORM 1023-EZ for ZACH SCHROCK MEMORIAL FUND

Field Data
EIN 86-3910512
Case Number EO-2021141-000477
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ZACH SCHROCK MEMORIAL FUND
Organization’s Mailing Address 27200 S FAMULINER RD
City HARRISONVILLE
State MO
ZIP 64701
Accounting period End 12
Primary contact name TRACI R SCHROCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TRACI SCHROCK
VICE PRESIDENT DIRECTOR
27200 S FAMULINER RD
HARRISONVILLE MO 64701

Officer/Director/Trustee Two

LEE LAWSON
DIRECTOR
12902 E ST RT 2
HARRISONVILLE MO 64701

Officer/Director/Trustee Three

WENDY SAFFELS
SECRETARY AND DIRECTOR
1410 E SOUTH ST
HARRISONVILLE MO 64701

Officer/Director/Trustee Four

DIANNA BUSH
TREASURER AND DIRECTOR
37863 BETHEL CHURCH RD
FORTUNA MO 65034

Officer/Director/Trustee Five

SHANE SCHROCK
PRESIDENT AND DIRECTOR
27200 S FAMULINER RD
HARRISONVILLE MO 64701

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/24/2020
Organization Incorporation State MT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G12 - 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TRACI SCHROCK
Signature Title VICE PRESIDENT DIRECTOR
Signature Date 5/18/2021

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