FORM 1023-EZ for PEDIATRIC STROKE WARRIORS

Field Data
EIN 47-4308118
Case Number EO-2015182-000222
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PEDIATRIC STROKE WARRIORS
Organization’s Mailing Address 14760 209TH AVE SE
City RENTON
State WA
ZIP 98059-8944
Accounting period End 12
Primary contact name KAYSEE HYATT- PRESIDENT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KAYSEE HYATT
PRESIDENT DIRECTOR
14760 209TH AVE SE
RENTON WA 98059-8944

Officer/Director/Trustee Two

AMY JAYNE
TREASURER
630 MALONEY GROVE AVE SE
NORTH BEND WA 98045-9033

Officer/Director/Trustee Three

TIM SHOULTZ
DIRECTOR
717 216TH AVE NE
SAMMAMISH WA 98074-3924

Officer/Director/Trustee Four

LYNDSEY WATSON
VICE- PRESIDENT
611 BALLARAT AVE N
NORTH BEND WA 98045-8231

Officer/Director/Trustee Five

CRYSTAL KLEIN
SECRETARY
12024 96TH AVE NE UNIT 420
KIRKLAND WA 98034-6226

Organization’s website WWW.PEDIATRICSTROKEWARRIORS.ORG
Organization’s email PEDWARRIORS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/10/2015
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - Fund Raising and/or Fund Distribution
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 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
Signature Title
Signature Date

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