FORM 1023-EZ for WORLEY STREET ROUNDTABLE

Field Data
EIN 47-3074182
Case Number EO-2015212-000077
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WORLEY STREET ROUNDTABLE
Organization’s Mailing Address 611 W WORLEY
City COLUMBIA
State MO
ZIP 65203
Accounting period End 12
Primary contact name JOHN G CLARK ATTORNEY AT LAW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

VERNA LABOY
TREASURER
611 W WORLEY
COLUMBIA MO 65203

Officer/Director/Trustee Two

ADRIAN CLIFTON
PRESIDENT
207 BRIARCREST CT
COLUMBIA MO 65203

Officer/Director/Trustee Three

DAVID AGUAYO
VICE-PRESIDENT
3700 VILLAGE PARK
COLUMBIA MO 65201

Officer/Director/Trustee Four

REBECCA AGUAYO
SECRETARY
3700 VILLAGE PARK
COLUMBIA MO 65201

Officer/Director/Trustee Five

NICOLE SMITH-MCGRUDER
BOARD MEMBER
611 W WORLEY
COLUMBIA MO 65203

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/28/2015
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
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 Yes
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
Signature Title
Signature Date

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