FORM 1023-EZ for POSITIVE PHOCUS INC

Field Data
EIN 86-2089289
Case Number EO-2021097-001107
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POSITIVE PHOCUS INC
Organization’s Mailing Address 2070 N CRUZE
City POST FALLS
State ID
ZIP 83854
Accounting period End 12
Primary contact name TANNER VEILLETTE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TANNER VEILLETTE
PRESIDENT / DIRECTOR
2070 N CRUZE
POST FALLS ID 83854

Officer/Director/Trustee Two

KELLY TARESKI
SECRETARY / VP/ DIRECTOR
17810 N SOUTHBANK RD
NINE MILE FALLS WA 99026

Officer/Director/Trustee Three

JUSTIN HOLIDAY
TREASURER / DIRECTOR
9816 E NORA AVE
SPOKANE WA 99206

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/12/2021
Organization Incorporation State ID
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F99 - Mental Health, Crisis Intervention 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 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 TANNER VEILLETTE
Signature Title PRESIDENT / DIRECTOR
Signature Date 3/17/2021

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