FORM 1023-EZ for VERMONT HIGHWAY SAFETY ALLIANCE

Field Data
EIN 81-1805660
Case Number EO-2016146-000097
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name VERMONT HIGHWAY SAFETY ALLIANCE
Organization’s Mailing Address 1 NATIONAL LIFE DR
City MONTPELIER
State VT
ZIP 05633
Accounting period End 12
Primary contact name SUSAN CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GLEN BUTTON
DIRECTOR
1 NATIONAL LIFE DR
MONTPELIER VT 05633

Officer/Director/Trustee Two

KEVIN MARSHIA
DIRECTOR
1 NATIONAL LIFE DR
MONTPELIER VT 05633

Officer/Director/Trustee Three

TED MINALL
DIRECTOR
1 NATIONAL LIFE DR
MONTPELIER VT 05633

Officer/Director/Trustee Four

SUSAN CLARK
SECRETARY/COORDINATOR
1 NATIONAL LIFE DR
MONTPELIER VT 05633

Organization’s website HTTP://HIGHWAYSAFETY.VERMONT.GOV
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/10/2012
Organization Incorporation State VT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M42 - Automotive Safety
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 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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