FORM 1023-EZ for EVERGREEN CHAMBER FOUNDATION

Field Data
EIN 46-0801664
Case Number EO-2015020-000126
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EVERGREEN CHAMBER FOUNDATION
Organization’s Mailing Address 12712 W KEN CARYL AVE
City LITTLETON
State CO
ZIP 80127
Accounting period End 12
Primary contact name BETH ANDERSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BETH ANDERSEN
DIRECTOR
12712 W KEN CARYL AVE
LITTLETON CO 80127

Officer/Director/Trustee Two

KELLY BREUER
DIRECTOR
29896 TROUTDALE PARK PLACE
EVERGREEN CO 80439

Officer/Director/Trustee Three

SUSAN HAMMOND
DIRECTOR
28265 HIGHWAY 74
EVERGREEN CO 80439

Officer/Director/Trustee Four

ANGELA RYAN
DIRECTOR
28267 HIGHWAY 74 UNIT E
EVERGREEN CO 80439

Organization’s website NA
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/16/2012
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W12 - Fund Raising and/or Fund Distribution
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 Yes
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 Yes
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
Signature Title
Signature Date

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