FORM 1023-EZ for HEALTH STAR INITIATIVE
| Field | Data |
|---|---|
| EIN | 86-1767352 |
| Case Number | EO-2021082-000294 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | HEALTH STAR INITIATIVE |
| Organization’s Mailing Address | 9996 W US HIGHWAY 50 STE 1223 |
| City | SALIDA |
| State | CO |
| ZIP | 81201 |
| Accounting period End | 12 |
| Primary contact name | CHRIS SKAGEN |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
CHRIS SKAGEN
CHAIR
1204 E STREET
SALIDA CO 81201-2538
Officer/Director/Trustee Two
ERIN LOWRIE
DIRECTOR
5635 D STREET
SPRINGFIELD OR 97478-5414
Officer/Director/Trustee Three
LISA FREEMAN
DIRECTOR
12166 SW PALERMO ST
WILSONVILLE OR 97070-7929
Officer/Director/Trustee Four
SAMANTHA MILES
DIRECTOR
4001 12 ST CUTOFF SE
SALEM OR 97302-1890
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/29/2021 |
| Organization Incorporation State | CO |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | B03 - Professional Societies, Associations |
| Organization’s purpose | Charitable: No Religious: No Educational: Yes Scientific: Yes 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 | CHRIS SKAGEN |
| Signature Title | CHAIR |
| Signature Date | 1/29/2021 |
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