FORM 1023-EZ for THE LEWIS COUNTY FOOD PANTRY INC

Field Data
EIN 82-2584784
Case Number EO-2018100-000013
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE LEWIS COUNTY FOOD PANTRY INC
Organization’s Mailing Address 408 CLARK STREET
City CANTON
State MO
ZIP 63435
Accounting period End 12
Primary contact name AMANDA GOSIK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AMANDA GOSIK
PRESIDENT
809 WASHINGTON ST
CANTON MO 63435

Officer/Director/Trustee Two

RICHARD HORNER
VICE PRESIDENT
28196 STATE HWY 16
CANTON MO 63435

Officer/Director/Trustee Three

JUDY EATON
SECRETARY
21031 STATE HWY P
CANTON MO 63435

Officer/Director/Trustee Four

MELISSA HOLT
TREASURER
903 WHITE ST
CANTON MO 63435

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/27/17
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 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 AMANDA GOSIK
Signature Title PRESIDENT
Signature Date 4/5/18

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