FORM 1023-EZ for NORTHWEST FIRST RESPONDERS RETREAT

Field Data
EIN 82-0963677
Case Number EO-2019074-000651
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NORTHWEST FIRST RESPONDERS RETREAT
Organization’s Mailing Address 29935 NE TOLT HILL ROAD
City CARNATION
State WA
ZIP 98014
Accounting period End 12
Primary contact name PHYLLIS ROGERS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PHYLLIS ROGERS
DIRECTOR
29935 NE TOLT HILL ROAD
CARNATION WA 98014

Officer/Director/Trustee Two

CHARILE SCOMA
DIRECTOR
5844 NE 75TH ST
SEATTLE WA 98115

Officer/Director/Trustee Three

JACQUELINE HEWITT
DIRECTOR
C/O 29935 NE TOLT HILL ROAD
CARNATION WA 98014

Officer/Director/Trustee Four

LLOYD BIRD
DIRECTOR
C/O 29935 NE TOLT HILL ROAD
CARNATION WA 98014

Officer/Director/Trustee Five

JOHN JIMENEZ
DIRECTOR
6720 154TH STREET
PUYALLUP WA 98375

Organization’s website NFRR.ORG
Organization’s email ADMIN@NFRR.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/3/17
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JACQUELINE HEWITT
Signature Title DIRECTOR
Signature Date 3/12/19

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