FORM 1023-EZ for MID WALLEY PANTHERS ATHLETICS

Field Data
EIN 85-3632405
Case Number EO-2021064-002369
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MID WALLEY PANTHERS ATHLETICS
Organization’s Mailing Address 1868 BLACKWOOD DR E
City MONMOUTH
State OR
ZIP 97361
Accounting period End 12
Primary contact name KAIOLANI CALIP
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KAIOLANI CALIP
PRESIDENT
1868 BLACKWOOD DR E
MONMOUTH OR 97361

Officer/Director/Trustee Two

ZACK SAPP
VICE PRESIDENT
435 RICHARDS CT E
MONMOUTH OR 97361

Officer/Director/Trustee Three

CARISSA MOORE
TREASURER
808 KNOX ST N
MONMOUTH OR 97361

Officer/Director/Trustee Four

SONJA SAPP
SECRETARY
435 RICHARDS CT E
MONMOUTH OR 97361

Organization’s website
Organization’s email midvalleypanthersor@gmail.com
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/28/2020
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 KAIOLANI CALIP
Signature Title PRESIDENT
Signature Date 1/15/2021

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