FORM 1023-EZ for GOOD SAMARITAN VILLAGE MISSION

Field Data
EIN 82-3084514
Case Number EO-2017297-000130
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GOOD SAMARITAN VILLAGE MISSION
Organization’s Mailing Address 227 N RAYMOND RD APT 17
City SPOKANE VALLEY
State WA
ZIP 99206-3735
Accounting period End 12
Primary contact name DARLENE HAWLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DARLENE R HAWLEY
PRESIDENT
227 N RAYMOND RD APT 17
SPOKANE VALLEY WA 99206-3735

Officer/Director/Trustee Two

TAMARA THOMPSON
VICE-PRESIDENT
EAST 10023-18TH AVE
SPOAKNE VALLEY WA 99206-3735

Officer/Director/Trustee Three

ANNE-LISE DEBROT
SECRETARY/TREASURER
227 N RAYMOND RD APT 17
SPOKANE VALLEY WA 99206-3735

Organization’s website
Organization’s email GSVMISSION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/26/2017
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
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 Yes
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
Signature Title
Signature Date

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