FORM 1023-EZ for OUTREACH INC

Field Data
EIN 38-3979014
Case Number EO-2015272-000337
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name OUTREACH INC
Organization’s Mailing Address 960 LIBERTY STREET SE SUITE 110
City SALEM
State OR
ZIP 97302
Accounting period End 12
Primary contact name CHRIS MATHENY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JERAMY WILLIAMS
PRESIDENT
11209 AMBIANCE WAY
FRANKLIN TN 37067

Officer/Director/Trustee Two

RICK ADAMS
DIRECTOR
871 EVANS STREET
KEIZER OR 97303

Officer/Director/Trustee Three

CHRIS MATHENY
DIRECTOR
960 LIBERTY STREET SE SUITE 110
SALEM OR 97302

Officer/Director/Trustee Four

AMY MCLEOD
DIRECTOR
938 MISTLETOE LOOP NORTH
KEIZER OR 97303

Officer/Director/Trustee Five

KEN RAWLINGS
DIRECTOR
337 PINTAIL AVE SE
SALEM OR 97306

Organization’s website N/A
Organization’s email OUTREACHJERAMY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/21/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P50 - Personal Social Services
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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