FORM 1023-EZ for HIGH 5 HOUSE

Field Data
EIN 81-5063893
Case Number EO-2017118-000198
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HIGH 5 HOUSE
Organization’s Mailing Address 10420 SE 194TH PL
City RENTON
State WA
ZIP 98055-7313
Accounting period End 5
Primary contact name MARY MALOTTE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARY MALOTTE
OWNER/ CEO
10420 SE 194TH PL
RENTON WA 98055-7313

Officer/Director/Trustee Two

ELLEN MALOTTE
CHAIRMAN/ VICE-PRESIDENT
10420 SE 194TH PL
RENTON WA 98055-7313

Officer/Director/Trustee Three

AVRIEL SKOLNICK
SECRATARY
3852 34TH AVE SW
SEATTLE WA 98126-2540

Organization’s website HTTPS://SITES.GOOGLE.COM/SITE/HIGH5HOUSEWA/
Organization’s email HIGH5HOUSEWA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/16/2016
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N50 - Recreational, Pleasure, or Social Club
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 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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