FORM 1023-EZ for MEDICINE LODGE HISTORICAL SOCIETY INC

Field Data
EIN 23-7048032
Case Number EO-2015280-000213
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MEDICINE LODGE HISTORICAL SOCIETY INC
Organization’s Mailing Address 209 W FOWLER
City MEDICINE LODGE
State KS
ZIP 67104
Accounting period End 12
Primary contact name ROBIN EUBANK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOHN NIXON
PRESIDENT
204 W FOWLER
MEDICINE LODGE KS 67104

Officer/Director/Trustee Two

ANN BELL
SECRETARY
928 N ELM
MEDICINE LODGE KS 67104

Officer/Director/Trustee Three

ROBIN EUBANK
TREASURER
915 N CEDAR
MEDICINE LODGE KS 67104

Officer/Director/Trustee Four

TYLER BELL
DIRECTOR
300 N ADAMS
MEDICINE LODGE KS 67104

Officer/Director/Trustee Five

MIKE JACOBS
DIRECTOR
412 W FOWLER
MEDICINE LODGE KS 67104

Organization’s website WWW.MEDICINELODGESTOCKADE.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/14/1969
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A50 - Museum, Museum Activities
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 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

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