FORM 1023-EZ for CHIPS FOR CHARITY

Field Data
EIN 82-3130716
Case Number EO-2018214-000215
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CHIPS FOR CHARITY
Organization’s Mailing Address 2509 SPANISH BAY DRIVE
City COLUMBIA
State MO
ZIP 65202
Accounting period End 12
Primary contact name DEREK CLIFTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEREK CLIFTON
VICE PRESIDENT
2509 SPANISH BAY DRIVE
COLUMBIA MO 65202

Officer/Director/Trustee Two

ALEX PALNER
PRESIDENT
414 MEIER DRIVE
JEFFERSON CITY MO 65109

Officer/Director/Trustee Three

MATT PRENGER
SECRETARY
2218 HIGHWAY 179
JEFFERSON CITY MO 65109

Officer/Director/Trustee Four

BRANDON BARLOW
TREASURER
1733 PROVIDENCE DRIVE
JEFFERSON CITY MO 65109

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/26/17
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other 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 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 Yes
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 DEREK CLIFTON
Signature Title VICE PRESIDENT
Signature Date 7/31/18

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