FORM 1023-EZ for DOUGLAS COUNTY SUICIDE PREVENTION COALITION

Field Data
EIN 81-0704867
Case Number EO-2016144-000185
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DOUGLAS COUNTY SUICIDE PREVENTION COALITION
Organization’s Mailing Address PO BOX 1025
City LAWRENCE
State KS
ZIP 66044-1025
Accounting period End 12
Primary contact name CHRISTOPHER MAXWELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRISTOPHER MAXWELL
CHAIR
1414 CLARE CT
LAWRENCE KS 66046-3222

Officer/Director/Trustee Two

STEVE LOPES
TREASURER
704 OHIO
LAWRENCE KS 66044-2364

Officer/Director/Trustee Three

ALICIA CUSANO
SECRETARY
1920 MOODIE RD
LAWRENCE KS 66046-3166

Officer/Director/Trustee Four

JOSE CORNEJO
VICE CHAIR
200 MCDONALD DR
LAWRENCE KS 66044-1057

Officer/Director/Trustee Five

ANNA BARGER
DIRECTOR
2721 W 6TH ST SUITE E
LAWRENCE KS 66049-4306

Organization’s website HTTPS://WWW.FACEBOOK.COM/DCSPC/
Organization’s email DCSPCOALITION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/1/2015
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: No
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
Signature Title
Signature Date

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