FORM 1023-EZ for LAWRENCE COUNTY CANCER RESOURCE CENTER

Field Data
EIN 46-1881747
Case Number EO-2017235-000476
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAWRENCE COUNTY CANCER RESOURCE CENTER
Organization’s Mailing Address 2765 CROCKETT ROAD
City ST FRANCISVILLE
State IL
ZIP 62460
Accounting period End 12
Primary contact name SUSAN GHER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JO DENNISON
PRESIDENT
1702 PORTER
LAWRENCEVILLE IL 62439

Officer/Director/Trustee Two

PAM NOLAN
VICE PRESIDENT
2503 SPRINGFIELD AVE
LAWRENCEVILLE IL 62439

Officer/Director/Trustee Three

JODI AYERS
SECRETARY/TREASURER
7977 OCTANE LANE
BRIDGEPORT IL 62417

Officer/Director/Trustee Four

DEBBIE MILLER
BOARD MEMBER
202 LEWIS AVE
LAWRENCEVILLE IL 62439

Officer/Director/Trustee Five

SUSAN GHER
BOARD MEMBER
2765 CROCKETT ROAD
ST FRANCISVILLE IL 62460

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/15/2013
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G30 - Cancer
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 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date
EIN 46-1881747
Case Number EO-2015078-000300
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAWRENCE COUNTY CANCER RESOURCE CENTER
Organization’s Mailing Address 2765 CROCKETT RD
City ST FRANCISVILLE
State IL
ZIP 62460
Accounting period End 12
Primary contact name SUSAN GHER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

EMILY JO DENNISON
PRESIDENT
1702 PORTER AVE
LAWRENCEVILLE IL 62439

Officer/Director/Trustee Two

PAM NOLAN
VICE PRESIDENT
2504 SPRINGFIELD AVE
LAWRENCEVILLE IL 62439

Officer/Director/Trustee Three

JODI AYERS
SECRETARY/TREASURER
7977 OCTANE LN
BRIDGEPORT IL 62417

Officer/Director/Trustee Four

SUSAN GHER
EXECUTIVE DIRECTOR
2765 CROCKETT RD
ST FRANCISVILLE IL 62460

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/15/2013
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P19 - Nonmonetary Support N.E.C.
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 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 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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