FORM 1023-EZ for LEISURE ACRES PHASE III

Field Data
EIN 20-5779684
Case Number EO-2015203-000307
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LEISURE ACRES PHASE III
Organization’s Mailing Address 215 W SAM J STONE AVENUE
City PEORIA
State IL
ZIP 61602
Accounting period End 12
Primary contact name RICHARD M JOSEPH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DANIEL GIEBELHAUSEN
PRESIDENT / DIRECTOR
1208 SPRINGFIELD ROAD
EAST PEORIA IL 61611

Officer/Director/Trustee Two

JAMES MAMER
SECRETARY / TREASURER / DIRECTOR
420 WILLOW COURT
EAST PEORIA IL 61611

Officer/Director/Trustee Three

DENNIS BECHTEL
VICE PRESIDENT / DIRECTOR
110 W BROOKFOREST DRIVE
PEORIA IL 61615

Officer/Director/Trustee Four

TOM TANKERSLEY
DIRECTOR
411 SCHMITT LANE
GERMANTOWN HILLS IL 61548

Officer/Director/Trustee Five

GARY DEITERS
DIRECTOR
2075 WASHINGTON ROAD
WASHINGTON IL 61571

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/15/2014
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L22 - Senior Citizens' Housing/Retirement Communities
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 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
Signature Title
Signature Date

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