FORM 1023-EZ for HEALTHY PINE RIVER

Field Data
EIN 47-5359441
Case Number EO-2015295-000409
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEALTHY PINE RIVER
Organization’s Mailing Address 933 RIVERVIEW DRIVE
City ALMA
State MI
ZIP 48801
Accounting period End 12
Primary contact name GARY RAYBURN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GARY RAYBURN
CHAIR
933 RIVERVIEW DRIVE
ALMA MI 48801

Officer/Director/Trustee Two

DAWN BRADY WIMMER
SECRETARY
5335 BLUE HERON DRIVE
ALMA MI 48801

Officer/Director/Trustee Three

CHUCK SANDRO
TREASURER
5375 BLUE HERON DRIVE
ALMA MI 48801

Officer/Director/Trustee Four

LYNN SANDRO
TREASURER
5375 BLUE HERON DRIVE
ALMA MI 48801

Officer/Director/Trustee Five

JANE KEON
DIRECTOR AT LARGE
5355 BLUE HERON DRIVE
ALMA MI 48801

Organization’s website WWW.HEALTHYPINERIVER.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/16/2015
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C99 - Environmental Quality, Protection, and Beautification N.E.C.
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 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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