FORM 1023-EZ for REFOCUS
| Field | Data |
|---|---|
| EIN | 82-4562730 |
| Case Number | EO-2018169-000445 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | REFOCUS |
| Organization’s Mailing Address | 2104 22ND AVE SE |
| City | OLYMPIA |
| State | WA |
| ZIP | 98501 |
| Accounting period End | 12 |
| Primary contact name | STACY HICKS |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
STACY HICKS
EXECUTIVE DIRECTOR
2104 22ND AVE SE
OLYMPIA WA 98501
Officer/Director/Trustee Two
DOUG FORD
PRESIDENT
7314 GOLDFINCH CT SE
LACEY WA 98503
Officer/Director/Trustee Three
MYA MACMILLAN
VICE PRESIDENT
319 QUICNE STREET
OLYMPIA WA 98506
Officer/Director/Trustee Four
BETH KOBER
TREASURER
2104 22ND AVE SE
OLYMPIA WA 98501
Officer/Director/Trustee Five
TRACEY CARLOS
SECRETARY
801 LILLY ROAD APT 234
OLYMPIA WA 98506
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/9/18 |
| Organization Incorporation State | WA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | A25 - Arts Education |
| 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 | 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 | STACY HICKS |
| Signature Title | EXECUTIVE DIRECTOR |
| Signature Date | 6/13/18 |
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