FORM 1023-EZ for LINCOLN CITY WARMING SHELTER

Field Data
EIN 47-4016431
Case Number EO-2015138-000343
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LINCOLN CITY WARMING SHELTER
Organization’s Mailing Address P O BOX 198
City LINCOLN CITY
State OR
ZIP 97367
Accounting period End 9
Primary contact name RICHARD GARTRELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RICHARD MUSICK
PRESIDENT
3880 EVERGREEN
DEPOE BAY OR 97341

Officer/Director/Trustee Two

MARK NICHOLSON
VICE PRESIDENT
CITY HALL PO BOX 50
LINCOLN CITY OR 97367

Officer/Director/Trustee Three

RICHARD GARTRELL
SECRETARY
2354 NE HOTSPUR LANE
LINCOLN CITY OR 97367

Officer/Director/Trustee Four

JAY ROELOF
TREASURER
P O BOX 945
LINCOLN CITY OR 97367

Officer/Director/Trustee Five

MIKE GROGAN
BOARD MEMBER
P O BOX 945
LINCOLN CITY OR 97367

Organization’s website
Organization’s email LINCOLNWARMINGSHELTER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/6/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
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 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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