FORM 1023-EZ for FAMILY CANCER SUPPORT CENTERS INC

Field Data
EIN 81-1043066
Case Number EO-2016013-000488
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FAMILY CANCER SUPPORT CENTERS INC
Organization’s Mailing Address 5542 NW JENNINGS RD
City TOPEKA
State KS
ZIP 66618-3110
Accounting period End 12
Primary contact name DARLA HAYES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DARLA HAYES
PRESIDENT / CEO
5542 NW JENNINGS RD
TOPEKA KS 66618-3110

Officer/Director/Trustee Two

MICHAEL DEXTER
FINANCIAL / CFO
5542 NW JENNINGS RD
TOPEKA KS 66618-3110

Officer/Director/Trustee Three

SARA UPHAUS
SECRETARY
4828 NW FIELDING PL APT 4
TOPEKA KS 66618-2556

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/11/2016
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G30 - Cancer
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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