FORM 1023-EZ for BRIGHAM SUICIDE PREVENTION

Field Data
EIN 81-5109293
Case Number EO-2017027-000344
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BRIGHAM SUICIDE PREVENTION
Organization’s Mailing Address PO BOX 186
City CORINNE
State UT
ZIP 84307
Accounting period End 12
Primary contact name BRETT MERKLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CARRIE RUTHERFORD
CHAIRMAN
PO BOX 186
CORINNE UT 84307

Officer/Director/Trustee Two

KAREN HARLOW
CO-CHAIRMAN
PO BOX 186
CORINNE UT 84307

Officer/Director/Trustee Three

EMILY PUGSLEY
SECRETARY
PO BOX 186
CORINNE UT 84307

Officer/Director/Trustee Four

BRETT MERKLEY
TREASURER
PO BOX 186
CORINNE UT 84307

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/4/2017
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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 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 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
Signature Title
Signature Date

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