FORM 1023-EZ for POMEROY ASSIST GARFIELD COUNTY HUMANITARIAN SERVICES

Field Data
EIN 83-2537144
Case Number EO-2018344-000362
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POMEROY ASSIST GARFIELD COUNTY HUMANITARIAN SERVICES
Organization’s Mailing Address POBOX804
City POMEROY
State WA
ZIP 99347-804
Accounting period End 12
Primary contact name ROGER PEDERSRN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROGER PEDERSEN
CHAIRMAN
PO BOX 442
POMEROY WA 99347-442

Officer/Director/Trustee Two

DAN LEWIS
SECRETARY
PO BOX 889
POMEROY WA 99347-889

Officer/Director/Trustee Three

DIANE KOLLER
TREASURER
3102 KIRBY MAYVIEW ROAD
POMEROY WA 99347

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/13/18
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 ROGER PEDERSEN
Signature Title CHAIRMAN
Signature Date 12/7/18

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