FORM 1023-EZ for CENTRAL OREGON BIRTH BEREAVEMENT

Field Data
EIN 83-2138528
Case Number EO-2018283-000392
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CENTRAL OREGON BIRTH BEREAVEMENT
Organization’s Mailing Address PO BOX 6982
City BEND
State OR
ZIP 97708
Accounting period End 12
Primary contact name JENNY ANDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNY ANDERSON
PRESIDENT
63275 OVERTREE ROAD
BEND OR 97701

Officer/Director/Trustee Two

JENNY LONG
SECRETARY
56624 RAVEN ROCK CIRCLE
BEND OR 97707

Officer/Director/Trustee Three

CASIE OZOLIN
BOARD MEMBER
2713 NW NIGHTFALL CIRCLE
BEND OR 97703

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 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 JENNY ANDERSON
Signature Title PRESIDENT
Signature Date 10/8/18

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