FORM 1023-EZ for CAROLYN KALTSCHNEE REVOCABLE TRUSTNUMBER 1

Field Data
EIN 86-6469525
Case Number EO-2021090-000547
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CAROLYN KALTSCHNEE REVOCABLE TRUSTNUMBER 1
Organization’s Mailing Address 311 BANKERS BLVD
City VANDALIA
State IL
ZIP 62471-2747
Accounting period End 12
Primary contact name JAY JOLLIFF
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAY JOLLIFF
TRUST OFFICER FNB COMMUNITY BANK
311 BANKER BLVD
VANDALIA IL 62471-2747

Organization’s website
Organization’s email
Organization Incorporated
Organization trust Yes
Necessary Organizing Documents Yes
Organization Incorporation Date 10/18/2020
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T11 - Single Organization Support
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 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 JAY JOLLIFF
Signature Title TRUST OFFICER FNB COMMUNITY BANK
Signature Date 2/18/2021

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