FORM 1023-EZ for ANDREW COUNTY HEALTH AND SAFETY COALITION

Field Data
EIN 84-2404739
Case Number EO-2019224-000250
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ANDREW COUNTY HEALTH AND SAFETY COALITION
Organization’s Mailing Address PO BOX 271
City SAVANNAH
State MO
ZIP 64485
Accounting period End 12
Primary contact name LINDSEY HOLCUMBRINK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAYNE WHITE
CHAIR
PO BOX 271
SAVANNAH MO 64485

Officer/Director/Trustee Two

GINA LUCAS
VICE CHAIR
411 COURT STREET
SAVANNAH MO 64485

Officer/Director/Trustee Three

LOREE MAGERS
SECRETARY
304 CATALPA STREET
SAVANNAH MO 64485

Officer/Director/Trustee Four

STEVE HUMPHREY
TREASURER
PO BOX 278
SAVANNAH MO 64485

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/17/19
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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 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 JAYNE WHITE
Signature Title CHAIR
Signature Date 8/8/19

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