FORM 1023-EZ for ROSE CITY HOCKEY CLUB

Field Data
EIN 46-3867429
Case Number EO-2015036-000269
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROSE CITY HOCKEY CLUB
Organization’s Mailing Address PO BOX 12526
City PORTLAND
State OR
ZIP 97212
Accounting period End 12
Primary contact name CAROLINE PARKS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CAROLINE PARKS
PRESIDENT/SECRETARY
3346 NE 14TH AVENUE
PORTLAND OR 97212

Officer/Director/Trustee Two

ROSEMARY KING
VICE PRESIDENT/TREASURER
2507 NW SAVIER ST
PORTLAND OR 97210

Officer/Director/Trustee Three

JESSICA MILLER
MEMBER AT LARGE
3242 NE 12TH AVENUE
PORTLAND OR 97212

Organization’s website WWW.ROSECITYHOCKEYCLUB.COM
Organization’s email INFO@ROSECITYHOCKEYCLUB.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/9/2013
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N68 - Winter Sports (Snow and Ice)
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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