FORM 1023-EZ for PERRY COUNTY LIFE CENTER INC

Field Data
EIN 47-5634441
Case Number EO-2017334-000371
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PERRY COUNTY LIFE CENTER INC
Organization’s Mailing Address 115 WASHINGTON STREET
City CANNELTON
State IN
ZIP 47525
Accounting period End 12
Primary contact name KATHY CLAYTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MCCAHEY KEITH
PRESIDENT
626 12TH STREET
TELL CITY IN 47586

Officer/Director/Trustee Two

DOYLE JAMES
VICE PRESIDENT
2937 GOERING ROAD
HAWESVILLE KY 42348

Officer/Director/Trustee Three

TONY KIMBREL
VICE PRESIDENT
911 9TH STREET
TELL CITY IN 47586

Officer/Director/Trustee Four

KATHY CLAYTON
TREASURER
427 18TH STREET
TELL CITY IN 47586

Officer/Director/Trustee Five

TERESA KANNEBERG
SECRETARY
7500 STATE ROAD 166
TOBINSPORT IN 47520

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/18/2015
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity Yes
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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