FORM 1023-EZ for OLIVE BROOK COMMUNITY

Field Data
EIN 82-1234839
Case Number EO-2017160-000216
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name OLIVE BROOK COMMUNITY
Organization’s Mailing Address 5730 CHAMBERLAIN AVE
City ST. LOUIS
State MO
ZIP 63112
Accounting period End 12
Primary contact name DERECK WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DERECK WILLIAMS SR
PRESIDENT
5730 CHAMBERLAIN AVE
ST. LOUIS MO 63112

Officer/Director/Trustee Two

IVY WILLIAMS
VICE PRESIDENT
5730 CHAMBERLAIN AVE
ST. LOUIS MO 63112

Officer/Director/Trustee Three

NIKITA BROWN
TREASURER
1258 DARR
ST. LOUIS MO 63137

Officer/Director/Trustee Four

RODNEY A UNDERWOOD
SECRETARY
324 BAILEY ROAD
CRYSTAL CITY MO 63019

Officer/Director/Trustee Five

RUFUS B MOORE
BOARD MEMBER
12441 MUSTONE LN
MARYLAND HEIGHTS MO 63146

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/19/2017
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 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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