FORM 1023-EZ for RAINIER ADAPTIVE SPORTS

Field Data
EIN 86-2955734
Case Number EO-2021250-000328
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name RAINIER ADAPTIVE SPORTS
Organization’s Mailing Address 2218 MELROSE ST
City TACOMA
State WA
ZIP 98405
Accounting period End 12
Primary contact name CHARLIE KATICA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHARLIE KATICA
PRESIDENT
8514 44TH STREET W
UNIVERSITY PLACE WA 98466

Officer/Director/Trustee Two

PARKER AYERS
EXECUTIVE DIRECTOR
2218 MELROSE ST
TACOMA WA 98405

Officer/Director/Trustee Three

ELIZABETH MURPHY
TREASURER
2404 ALLEN ST APT D 113
KELSO WA 98626

Officer/Director/Trustee Four

MATTHEW MICKUNAS
VICE PRESIDENT
1109 NUNNALLY AVE NW
ORTING WA 98360

Officer/Director/Trustee Five

NOAH SEIDEL
SECRETARY
12150 SE 62 PL
BELLEVUE WA 98006

Organization’s website WWW.RAINIERADAPTIVESPORTS.ORG
Organization’s email PARKER@RASPORTS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/8/2021
Organization Incorporation State WA
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: 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CHARLIE KATICA
Signature Title PRESIDENT
Signature Date 9/2/2021

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