FORM 1023-EZ for DAVID AND GLORIA FISSELL FOUNDATION

Field Data
EIN 81-1892456
Case Number EO-2016092-000282
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DAVID AND GLORIA FISSELL FOUNDATION
Organization’s Mailing Address 502 ELMHURST DRIVE
City ST. CHARLES
State MO
ZIP 63301-4648
Accounting period End 12
Primary contact name DAVID FISSELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAVID FISSELL
PRESIDENT AND TREASURER
502 ELMHURST DRIVE
ST. CHARLES MO 63301-4648

Officer/Director/Trustee Two

CYNTHIA ROSADO
VICE PRESIDENT
710 S CARRIAGE XING
NIXA MO 65714-7163

Officer/Director/Trustee Three

GINA ARCOBASSO
SECRETARY
1052 OLIVE STREET
ST. CHARLES MO 63301-4712

Organization’s website WWW.DGFCARES.ORG
Organization’s email DAVID@DGFCARES.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/11/2016
Organization Incorporation State MO
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 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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