FORM 1023-EZ for THE KOTA FOUNDATION

Field Data
EIN 47-3560867
Case Number EO-2015131-000243
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE KOTA FOUNDATION
Organization’s Mailing Address 6663 SW BEAVERTON HILLSDALE HWY
City BEAVERTON
State OR
ZIP 97225
Accounting period End 12
Primary contact name DEBBIE ETHELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JASON REYNOLDS
PRESIDENT
1220 SW 12TH AVE APT 309
PORTLAND OR 97205

Officer/Director/Trustee Two

DEBRA LUKAN
TREASURER
260 NW PRESCOTT PLACE
BEAVERTON OR 97006

Officer/Director/Trustee Three

CAROLYN MCBRIDE
SECRETARY
3160 SW WESTWOOD DRIVE
PORTLAND OR 97225

Officer/Director/Trustee Four

DEBBIE ETHELL
EXECUTIVE DIRECTOR / OFFICER
6663 SW BEAVERTON HILLSDALE HWY
BEAVERTON OR 97225

Organization’s website NON-APPLICABLE
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/2/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D31 - Protection of Endangered Species
Organization’s purpose Charitable: No
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 Yes
Donation of funds Yes
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
Signature Title
Signature Date

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