FORM 1023-EZ for COMMUNITY LEADERS IMPACTING CHANGEIN KANSAS CITY INC

Field Data
EIN 81-3880199
Case Number EO-2016274-000185
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COMMUNITY LEADERS IMPACTING CHANGEIN KANSAS CITY INC
Organization’s Mailing Address 14720 WOODWARD STREET
City OVERLAND PARK
State KS
ZIP 66223-2782
Accounting period End 12
Primary contact name DEAN WALSTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LANCE COLLINS
DIRECTOR, PRESIDENT
6020 WEST 99TH TERRACE
OVERLAND PARK KS 66207-2812

Officer/Director/Trustee Two

DEAN WALSTON
DIRECTOR, SECRETARY
14720 WOODWARD STREET
OVERLAND PARK KS 66223-2782

Officer/Director/Trustee Three

ERICA OSTROSKI
DIRECTOR
8319 MACKEY STREET
OVERLAND PARK KS 66212-2729

Officer/Director/Trustee Four

LAURIE SANTEE
DIRECTOR
9622 WEST 124TH TERRACE
OVERLAND PARK KS 66213-1834

Officer/Director/Trustee Five

BRYCE ANDERSON
DIRECTOR, TREASURER
16323 WEST 165TH STREET
OLATHE KS 66062-7919

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/30/2016
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other 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 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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