FORM 1023-EZ for PLAY TO BEAT BRAIN CANCER INC

Field Data
EIN 47-3206251
Case Number EO-2018249-000306
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PLAY TO BEAT BRAIN CANCER INC
Organization’s Mailing Address 14669 S RENE ST
City OLATHE
State KS
ZIP 66062-8860
Accounting period End 12
Primary contact name STEPHEN MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STEPHEN MILLER
PRESIDENT
14669 S RENE ST
OLATHE KS 66062-8860

Officer/Director/Trustee Two

DEREK MILLER
VICE PRESIDENT
4400 GRANDVIEW RD
KANSAS CITY MO 64137-1850

Officer/Director/Trustee Three

DANIELLE HAUS
TREASURER
812 GIVAN
BELTON MO 64012-2387

Officer/Director/Trustee Four

ROGER ANDERSON
DIRECTOR
11081 ANTIOCH RD
OVERLAND PARK KS 66210-3218

Officer/Director/Trustee Five

JOHNNIE REED
SECRETARY
7601 NW 75TH ST
KANSAS CITY MO 64152-2372

Organization’s website WWW.PTBBC.ORG
Organization’s email STEVE.MILLER@PTBBC.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/4/15
Organization Incorporation State KS
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name STEPHEN MILLER
Signature Title PRESIDENT
Signature Date 9/4/18

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