FORM 1023-EZ for ANDERSON VALLEY VILLAGE

Field Data
EIN 82-1929118
Case Number EO-2018292-000258
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ANDERSON VALLEY VILLAGE
Organization’s Mailing Address 13325 ESTATE DRIVE
City BOONVILLE
State CA
ZIP 95415
Accounting period End 7
Primary contact name PHILIP THOMAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PHILIP THOMAS
PRESIDENT
13325 ESTATE DRIVE
BOONVILLE CA 95415

Officer/Director/Trustee Two

STEPHANIE GOLD
VICE PRESIDENT
13325 ESTATE DRIVE
BOONVILLE CA 95415

Officer/Director/Trustee Three

DONNA PIERSON-PUGH
SECRETARY
13325 ESTATE DRIVE
BOONVILLE CA 95415

Officer/Director/Trustee Four

GWYN SMITH
TREAS.
13325 ESTATE DRIVE
BOONVILLE CA 95415

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 CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
Organization’s purpose Charitable: Yes
Religious: No
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 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 PHILIP THOMAS
Signature Title PRESIDENT
Signature Date 10/17/18

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