FORM 1023-EZ for PLAY HORSE RANCH

Field Data
EIN 84-4127467
Case Number EO-2020057-000234
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PLAY HORSE RANCH
Organization’s Mailing Address 3326 103RD AVE SE
City LAKE STEVENS
State WA
ZIP 98258
Accounting period End 12
Primary contact name JAMES VANDECOEVERING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CAROLYN TRENT
OWNER / BOARD
3579 NE KILLINGSWORTH
PORTLAND OR 97211

Officer/Director/Trustee Two

JAMES VANDECOEVERING
CEO / BOARD
3326 103RD AVE SE
LAKE STEVENS WA 98258

Officer/Director/Trustee Three

JIM KUNZE
BOARD OFFICER
6926 SE NEHALEM ST
PORTLAND OR 97206

Officer/Director/Trustee Four

RICHARD BOUDREAUX
BOARD OFFICER
8920 EVERGREEN WAY APT 332
EVERETT WA 98208

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2020
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: No
Religious: No
Educational: No
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 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 JAMES VANDECOEVERING
Signature Title CEO / BOARD
Signature Date 2/24/2020

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