FORM 1023-EZ for MISSOURI HAITIAN RELIEF FUND

Field Data
EIN 80-0529853
Case Number EO-2014245-000322
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MISSOURI HAITIAN RELIEF FUND
Organization’s Mailing Address 1904 W MAIN STREET
City JEFFERSON CITY
State MO
ZIP 65109
Accounting period End 12
Primary contact name VICKI LIERHEIMER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DOUGLAS BOUDREAU
PRESIDENT
1904 W MAIN STREET
JEFFERSON CITY MO 65109

Officer/Director/Trustee Two

JANE BOUDREAU
TREASURER
5524 WEST 82ND STREET
PRAIRIE VILLAGE KS 66208

Officer/Director/Trustee Three

ELIZABETH SWAIM
SECRETARY
106 E JEFFERSON
MARTINSBURG MO 65264

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/19/2010
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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