FORM 1023-EZ for CHARITABLE PHARMACY GROUP

Field Data
EIN 81-4804884
Case Number EO-2017027-000301
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHARITABLE PHARMACY GROUP
Organization’s Mailing Address 1614 S CANYON WOODS LN
City SPOKANE
State WA
ZIP 99224-5734
Accounting period End 12
Primary contact name REBECCA VAN KEULEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MANPREET CHAHAL
PRESIDENT
8905 N KENSINGTON DR
SPOKANE WA 99208-8886

Officer/Director/Trustee Two

REBECCA VAN KEULEN
CHAIRPERSON
1614 S CANYON WOODS LN
SPOKANE WA 99224-5734

Officer/Director/Trustee Three

MIKE SCHROCK
DIRECTOR
4710 S SAINT ANDREWS LN
SPOKANE WA 99223-4300

Officer/Director/Trustee Four

BRADLEY TUBBS
DIRECTOR
8712 NE 37TH ST
VANCOUVER WA 98662-7547

Officer/Director/Trustee Five

JONATHAN STABEN
DIRECTOR
737 W SHOSHONE PL
SPOKANE WA 99203-2053

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2017
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G02 - Management & Technical Assistance
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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