FORM 1023-EZ for THE MEDORA HOUSE INC

Field Data
EIN 84-1939738
Case Number EO-2019154-000448
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE MEDORA HOUSE INC
Organization’s Mailing Address 8311 MEDORA ROAD
City HUTCHINSON
State KS
ZIP 67502
Accounting period End 12
Primary contact name RONALD J MANDEVILLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RONALD J MANDEVILLE
CHAIRMAN
8311 MEDORA ROAD
HUTCHINSON KS 67502

Officer/Director/Trustee Two

MIKE ORPIN
SECRETARY
554 ARAPAHO RD
INMAN KS 67546

Officer/Director/Trustee Three

BILL WESTOVER
TREASURER
8217 E 82ND AVE
HUTCHINSON KS 67502

Officer/Director/Trustee Four

MACK TOLBERT
BOARD MEMBER
726 E 2ND AVE APT C
HUTCHINSON KS 67501

Officer/Director/Trustee Five

DAVE HAWTHORNE
BOARD MEMBER
7707 N MONROE
HUTCHINSON KS 67502

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/10/19
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name RONALD J MANDEVILLE
Signature Title CHAIRMAN
Signature Date 5/31/19

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