FORM 1023-EZ for COFFEY COUNTY CANCER SUPPORT GROUPINC

Field Data
EIN 47-3437234
Case Number EO-2015085-000454
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COFFEY COUNTY CANCER SUPPORT GROUPINC
Organization’s Mailing Address 815 KENNEDY ST
City BURLINGTON
State KS
ZIP 66839
Accounting period End 12
Primary contact name MARTHA M NEWKIRK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHERRI D O KEEFE
PRESIDENT
815 KENNEDY ST
BURLINGTON KS 66839

Officer/Director/Trustee Two

MARTHA M NEWKIRK
VICE-PRESIDENT
1390 LYNX RD SW
BURLINGTON KS 66839

Officer/Director/Trustee Three

RONDA TRUELOVE
SECRETARY
315 MIAMI ST
BURLINGTON KS 66839

Officer/Director/Trustee Four

PAM SCOTT
TREASURER
804 SANDERS
BURLINGTON KS 66839

Officer/Director/Trustee Five

MARILYN STORRER
DIRECTOR
535 OAK ST
LEBO KS 66856

Organization’s website FACEBOOK.COM/CCCANCERSUPPORTGROUP
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/26/2015
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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 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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