FORM 1023-EZ for ORAL HEALTH COALITION OF SOUTHEASTMISSOURI

Field	Data
EIN	84-2435336
Case Number	EO-2019203-000217
Form 1023-EZ version	12018
Eligibility Worksheet	1
Organization Name	ORAL HEALTH COALITION OF SOUTHEASTMISSOURI
Organization’s Mailing Address	937 BROADWAY STREET SUITE 306
City	CAPE GIRARDEAU
State	MO
ZIP	63701
Accounting period End	12
Primary contact name	ALEXANDER H KUEHLING
Primary contact phone	[Hidden]
Primary contact phone extension	[Hidden]
Primary contact fax	[Hidden]
User fee submitted	$275.00

Officer/Director/Trustee One

MELISSA STICKEL
PRESIDENT
937 BROADWAY STREET SUITE 306
CAPE GIRARDEAU MO 63701

Officer/Director/Trustee Two

JANET RUOPP
DIRECTOR
937 BROADWAY STREET SUITE 306
CAPE GIRARDEAU MO 63701

Officer/Director/Trustee Three

TERRY SPENCE
DIRECTOR
937 BROADWAY STREET SUITE 306
CAPE GIRARDEAU MO 63701

Officer/Director/Trustee Four

CHRISTINE SCHOOLMAN
DIRECTOR
937 BROADWAY STREET SUITE 306
CAPE GIRARDEAU MO 63701

Officer/Director/Trustee Five

JOHN FREEZE
DIRECTOR
937 BROADWAY STREET SUITE 306
CAPE GIRARDEAU MO 63701

Organization’s website	N/A
Organization’s email	DIRECTOR@CPSEMO.ORG
Organization Incorporated	Yes
Organization trust	No
Necessary Organizing Documents	Yes
Organization Incorporation Date	5/7/19
Organization Incorporation State	MO
Contains Limitation	Yes
Does not expressly empower	Yes
Contains dissolution	Yes
National Taxonomy of Exempt Entities (NTEE) code	W01 - Alliance/Advocacy Organizations
Organization’s purpose	Charitable: Yes Religious: No Educational: Yes Scientific: Yes 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	No
Disaster relief assistance	No
One Third Support Public	No
One Third Support Gifts	No
Benefit of College	No
Private Foundation 508(e)	Yes
Seeking Retroactive Reinstatement	No
Seeking Section 7 Reinstatement	Yes
Correctness Declaration	Yes
Signature Name	MELISSA STICKEL
Signature Title	PRESIDENT
Signature Date	7/18/19
EIN	84-2435336
Case Number	EO-2019203-000217
Form 1023-EZ version	12018
Eligibility Worksheet	1
Organization Name	ORAL HEALTH COALITION OF SOUTHEAST MISSOURI
Organization’s Mailing Address	937 BROADWAY STREET SUITE 306
City	CAPE GIRARDEAU
State	MO
ZIP	63701
Accounting period End	12
Primary contact name	ALEXANDER H KUEHLING
Primary contact phone	[Hidden]
Primary contact phone extension	[Hidden]
Primary contact fax	[Hidden]
User fee submitted	$275.00