FORM 1023-EZ for QCBMF

Field Data
EIN 81-3615559
Case Number EO-2016251-000235
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name QCBMF
Organization’s Mailing Address 2228 S DELAWARE AVE
City SPRINGFIELD
State MO
ZIP 65804-3214
Accounting period End 1
Primary contact name SHANNON MEDLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUSTIN BOLIN
PRESIDENT
116 S TEAKWOOD ST
REPUBLIC MO 65738-2073

Officer/Director/Trustee Two

JEREMY MEDLEY
VICE PRESIDENT
2228 S DELAWARE AVE
SPRINGFIELD MO 65804-3214

Officer/Director/Trustee Three

SHANNON MEDLEY
TREASURER
2228 S DELAWARE AVE
SPRINGFIELD MO 65804-3214

Officer/Director/Trustee Four

MELANIE BOLIN
SECRETARY
116 S TEAKWOOD ST
REPUBLIC MO 65738-2073

Officer/Director/Trustee Five

MICHELLE HETHCOAT
MEDIA COORDINATOR
105 W ELM ST
STRAFFORD MO 65757-8221

Organization’s website WWW.QUEENCITYBEARDS.COM
Organization’s email QUEENCITYBEARDS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/4/2016
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
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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