FORM 1023-EZ for LIVE WELL LIVE ATCHISON INC

Field Data
EIN 47-2125575
Case Number EO-2014314-000065
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIVE WELL LIVE ATCHISON INC
Organization’s Mailing Address 800 RAVEN HILL DRIVE
City ATCHISON
State KS
ZIP 66002
Accounting period End 12
Primary contact name PATSY A PORTER CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRIS TAYLOR
PRESIDENT/DIRECTOR
1642 MAIN STREET STE 1
ATCHISON KS 66002

Officer/Director/Trustee Two

JACQUE PREGONT
TREASURER/SECRETARY/DIRECTOR
200 SOUTH 10TH STREET
ATCHISON KS 66002

Officer/Director/Trustee Three

GOLDIE BOLDRIDGE-BROWN
VICE PRESIDENT/DIRECTOR
3228 US 73 HWY
ATCHISON KS 66002

Officer/Director/Trustee Four

STEPHEN WISEMAN
DIRECTOR
306 MAIN STREET
EFFINGHAM KS 66023

Officer/Director/Trustee Five

STEPHEN PICKMAN
DIRECTOR
1501 BROOKDALE DRIVE
ATCHISON KS 66002

Organization’s website WWW.LIVEWELLATCHISON.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/3/2014
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
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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