FORM 1023-EZ for THE UNBROKEN FOUNDATION

Field Data
EIN 46-1238970
Case Number EO-2020240-000381
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE UNBROKEN FOUNDATION
Organization’s Mailing Address 1529 29TH AVE SE
City PUYALLUP
State WA
ZIP 98374
Accounting period End 10
Primary contact name BRIAN MOORE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRIAN MOORE
PRESIDENT
16125 JUAN WOOD WAY NE N103
BOTHELL WA 98011-6490

Officer/Director/Trustee Two

DAVID DIERCKINS
TREASURER
2903 S LAURELHURST DR
BOISE ID 83705

Officer/Director/Trustee Three

HENRY CRAMER
VICE PRESIDENT
2630 N BENNETT ST
TACOMA WA 98407-3318

Organization’s website WWW.THEUNBROKENFOUNDATION.ORG
Organization’s email BRIAN@THEUNBROKENFOUNDATION.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/25/2012
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - Fund Raising and/or Fund Distribution
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name BRIAN MOORE
Signature Title PRESIDENT
Signature Date 8/25/2020

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