FORM 1023-EZ for PERSONALIZED ADAPTIVE LIVING SOLUTIONS

Field Data
EIN 47-2531219
Case Number EO-2015016-000145
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PERSONALIZED ADAPTIVE LIVING SOLUTIONS
Organization’s Mailing Address 336 EAST RIPA AVE
City ST. LOUIS
State MO
ZIP 63125
Accounting period End 10
Primary contact name SHAWN KELLY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHAWN KELLY
EXECUTIVE DIRECTOR
75 SUN COURT
HIGHLAND IL 62249

Officer/Director/Trustee Two

ANNA ROSE
BOARD PRESIDENT
201 SOUTHAMPTON
ST. LOUIS MO 63125

Officer/Director/Trustee Three

RICHARD RISSE
BOARD SECRETARY
306 OAK RIDGE PARKWAY
ARNOLD MO 63010

Officer/Director/Trustee Four

MOLLY CALCATERRA
BOARD TREASURER
6320 ARTHUR AVENUE
ST. LOUIS MO 63139

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/29/2014
Organization Incorporation State MO
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 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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