FORM 1023-EZ for MONITEAU COUNTY HEALTHY LIFESTYLES

Field Data
EIN 86-3000493
Case Number EO-2021161-000281
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MONITEAU COUNTY HEALTHY LIFESTYLES
Organization’s Mailing Address PO BOX 65
City CALIFORNIA
State MO
ZIP 65018
Accounting period End 12
Primary contact name VANDEE MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VANDEE MILLER
CHAIR
299 ROBERTSON ROAD
CALIFORNIA MO 65018

Officer/Director/Trustee Two

JENNIFER MILLARD
CO-CHAIR SECRETARY
4031 OXFORD ROAD
JEFFERSON CITY MO 65109

Officer/Director/Trustee Three

TAWNYA CLAUSE
TREASURER
57360 QUENTON DR
CALIFORNIA MO 65018

Officer/Director/Trustee Four

KARLA WOOD
MEMBERSHIP CHAIR
66703 QUENTON DR
CALIFORNIA MO 65025

Officer/Director/Trustee Five

FRANK HENSLEY
VOTING MEMBER
29248 HWY 87
CALIFORNIA MO 65018

Organization’s website
Organization’s email VANDEE.MILLER@BURRELLCENTER.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/30/2011
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F21 - Alcohol, Drug Abuse, Prevention Only
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 VANDEE MILLER
Signature Title CHAIR
Signature Date 6/8/2021

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