FORM 1023-EZ for BROKEN H RESCUE RANCH

Field Data
EIN 84-1736354
Case Number EO-2019140-000164
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BROKEN H RESCUE RANCH
Organization’s Mailing Address 12175 NW SUMPTER DR
City TERREBONNE
State OR
ZIP 97760
Accounting period End 12
Primary contact name DANNYEL USHER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANNYEL USHER
PRESIDENT
12175 NW SUMPTER DR
TERREBONNE OR 97760

Officer/Director/Trustee Two

BRADLEY WOOSLEY
VICE PRESIDENT
11815 NW 10TH ST
TERREBONNE OR 97760

Officer/Director/Trustee Three

DAVID USHER
TREASURER
12175 NW SUMPTER DR
TERREBONNE OR 97760

Officer/Director/Trustee Four

KELEEN WOOSLEY
SECRETARY
11815 NW 10TH ST
TERREBONNE OR 97760

Organization’s website
Organization’s email BROKENHRESCUERANCH@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/10/19
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D99 - Animal-Related N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
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 DANNYEL USHER
Signature Title PRESIDENT
Signature Date 5/16/19

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