FORM 1023-EZ for KXRW

Field Data
EIN 81-3011370
Case Number EO-2018162-000501
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KXRW
Organization’s Mailing Address 15712 NE 28TH CIRCLE
City VANCOUVER
State WA
ZIP 98686-1533
Accounting period End 12
Primary contact name SUSAN GALAVIZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSAN GALAVIZ
EXECUTIVE BOARD CHAIR, PRESIDENT
15712 NE 28TH COURT
VANCOUVER WA 98686-1533

Officer/Director/Trustee Two

TOM DONOVAN
EXECUTIVE BOARD TREASURER
8813 NE 15TH STREET
VANCOUVER WA 98664-2492

Officer/Director/Trustee Three

JOE CLEMONS
EXECUTIVE BOARD SECRETARY
611 NW 44TH STREET
VANCOUVER WA 98660-1610

Officer/Director/Trustee Four

MARCIA HALE
EXECUTIVE BOARD VICE CHAIR
120 NE 136TH AVENUE NUMBER 215
VANCOUVER WA 98684-6964

Officer/Director/Trustee Five

PHIL BUSSE
FISCAL SPONSOR
1639 SE 37TH AVENUE
PORTLAND OR 97214-5133

Organization’s website HTTPS://WWW.KXRWVANCOUVER.ORG
Organization’s email SUSAN.GALAVIZ@KXRWVANCOUVER.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/12/16
Organization Incorporation State WA
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 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 SUSAN GALAVIZ
Signature Title EXECUTIVE BOARD CHAIR, PRESIDENT
Signature Date 6/9/18

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