FORM 1023-EZ for STORM WATER POLO INC

Field Data
EIN 82-2921059
Case Number EO-2018010-000072
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name STORM WATER POLO INC
Organization’s Mailing Address 19612 HOLLYGRAPE STREET
City BEND
State OR
ZIP 97702
Accounting period End 12
Primary contact name KIMBERLY NORBY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KIMBERLY NORBY
PRESIDENT/DIRECTOR
16912 HOLLYGRAPE STREET
BEND OR 97702

Officer/Director/Trustee Two

JENNIFER CLIFTON
SECRETARY/DIRECTOR
1735 SW CHANDLER AVENUE SUITE 1
BEND OR 97702

Officer/Director/Trustee Three

TAMMY CARUSO
DIRECTOR
PO BOX 313
BEND OR 97709

Officer/Director/Trustee Four

STEPHANIE RUIZ
TREASURER/DIRECTOR
19591 GREATWOOD LOOP
BEND OR 97702

Officer/Director/Trustee Five

SUSAN COLLINS
DIRECTOR
2005 HARRIMAN
BEND OR 97703

Organization’s website
Organization’s email NORBY@BENDBROADBAND.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/27/17
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N67 - Swimming, Water Recreation
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name KIMBERLY NORBY
Signature Title PRESIDENT/DIRECTOR
Signature Date 1/7/18

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