FORM 1023-EZ for NICA PAWS RESCUE CLINIC

Field Data
EIN 82-3905573
Case Number EO-2018012-000271
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NICA PAWS RESCUE CLINIC
Organization’s Mailing Address 600 EAST HOPKINS AVENUE
City ASPEN
State IL
ZIP 81611
Accounting period End 12
Primary contact name DONNA JACOBSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL WATERS
PRESIDENT TREASURER
PO BOX 8237
ASPEN CO 81612-8237

Officer/Director/Trustee Two

ADDELAIDE WATERS
SECRETARY
PO BOX 8237
ASPEN CO 81612-8237

Officer/Director/Trustee Three

CRAIG MARTIN
DIRECTOR
3810 RUN DRIVE
BIRMINGHAM AL 35243

Officer/Director/Trustee Four

SCOTT DOLGINOW
DIRECTOR
125 EAST 300 SOUTH
MOAB UT 84532

Officer/Director/Trustee Five

PATSY WILMERDING
DIRECTOR
125 EAST 300 SOUTH
MOAB UT 84532

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/5/18
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D40 - Veterinary Services
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 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 MICHAEL WATERS
Signature Title PRESIDENT TREASURER
Signature Date 1/10/18

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