FORM 1023-EZ for BOOTHEEL MEDICAL TRANSPORTATION CORPORATION

Field Data
EIN 81-3015872
Case Number EO-2016187-000330
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BOOTHEEL MEDICAL TRANSPORTATION CORPORATION
Organization’s Mailing Address 511 DIXIE STREET
City PARMA
State MO
ZIP 63870
Accounting period End 12
Primary contact name SHIRLEY HARRIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARIA MORGAN
DIRECTOR
PORTAGE VILLAGE APT 40
PORTAGEVILLE MO 63873

Officer/Director/Trustee Two

ANTONIA JOHANN
DIRECTOR
420 ILLINOIS AVE
SIKESTON MO 63801

Officer/Director/Trustee Three

ALISHA MOORE
DIRECTOR
106B SOUTH ILLINOIS AVE
SIKESTON MO 63801

Officer/Director/Trustee Four

SHIRLEY HARRIS
PRESIDENT
511 DIXIE STREET
PARMA MO 63870

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/22/2016
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 Yes
Donation of funds Yes
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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