FORM 1023-EZ for PLATEAU VALLEY CANCER FUND

Field Data
EIN 82-3419660
Case Number EO-2018009-000048
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PLATEAU VALLEY CANCER FUND
Organization’s Mailing Address PO BOX 424
City COLLBRAN
State CO
ZIP 81624-424
Accounting period End 12
Primary contact name JOYCE CHICOS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOYCE CHICOS
PRESIDENT
57462 OE ROAD
COLLBRAN CO 81624

Officer/Director/Trustee Two

TAMERA CLARK
VICE PRESIDENT
53599 LE 2/10 ROAD
MOLINA CO 81646

Officer/Director/Trustee Three

MELISSA WALLACE
SECRETARY/TREASURER
15131 57-1/2 ROAD
COLLBRAN CO 81624

Organization’s website
Organization’s email PVCANCERFUND@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/15/17
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 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 JOYCE CHICOS
Signature Title PRESIDENT
Signature Date 1/7/18

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