FORM 1023-EZ for MID AMERICA TEEN COMMUNITY EMERGENCY RESPONSE TEAM

Field Data
EIN 27-1623014
Case Number EO-2015239-000156
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MID AMERICA TEEN COMMUNITY EMERGENCY RESPONSE TEAM
Organization’s Mailing Address 424 AUTUMN FARMS COURT
City WENTZVILLE
State MO
ZIP 63385-3082
Accounting period End 12
Primary contact name MARK ROSENBLUM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARK ROSENBLUM
PRESIDENT
424 AUTUMN FARMS COURT
WENTZVILLE MO 63385-3082

Officer/Director/Trustee Two

MICHELLE BASILLE
VICE PRESIDENT
808 SCHAPER ROAD
FORISTELL MO 63348-1515

Officer/Director/Trustee Three

LAFAYE YOUNG
SECRETARY
12140 WAKEFIELD PLACE
MARYLAND HEIGHTS MO 63043-1229

Officer/Director/Trustee Four

EMILY ROSENBLUM
VICE PRESIDENT
424 AUTUMN FARMS COURT
WENTZVILLE MO 63385-3082

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/13/2012
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M20 - Disaster Preparedness and Relief Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: Yes
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 Yes
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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