FORM 1023-EZ for MODOC BROADCASTING

Field Data
EIN 46-5250789
Case Number EO-2017058-000485
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MODOC BROADCASTING
Organization’s Mailing Address 6343 SHASTA WAY
City KLAMATH FALLS
State OR
ZIP 97603-5265
Accounting period End 9
Primary contact name RANDY HENRY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RANDY HENRY
PRESIDENT
6343 SHASTA WAY
KLAMATH FALLS OR 97603-5265

Officer/Director/Trustee Two

STEVEN MOSTTLER
SECRETARY
502 CHARLEY ST NUMBER 13
CHILOQUIN OR 97624

Officer/Director/Trustee Three

DELORES GONZALES
TREASURER
6343 SHASTA WAY
KLAMATH FALLS OR 97603-5265

Officer/Director/Trustee Four

GILBERT JACKSON
VICE PRESIDENT
214 COLT ST
CHILOQUIN OR 97624

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/20/2014
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A34 - Radio
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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