FORM 1023-EZ for TRI-CITIES DIABETES COALITION

Field Data
EIN 81-3755841
Case Number EO-2018068-000099
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TRI-CITIES DIABETES COALITION
Organization’s Mailing Address 7102 W OKANOGAN PLACE
City KENNEWICK
State WA
ZIP 99336-2341
Accounting period End 12
Primary contact name AMY PERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAILI ABD LATIF
PRESIDENT
7102 W OKANOGAN PLACE
KENNEWICK WA 99336-2341

Officer/Director/Trustee Two

JENNIFER ASMUS
TREASURER
1979 SNYDER ST
RICHLAND WA 99354

Officer/Director/Trustee Three

RAQUEL GONZALEZ
SECRETARY
7102 W OKANOGAN PLACE
KENNEWICK WA 99336-2341

Officer/Director/Trustee Four

CYNTHIA WAGNER
PAST PRESIDENT
2003 SCOTTLAND COURT
WEST RICHLAND WA 99353

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/28/17
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G80 - Specifically Named Diseases
Organization’s purpose Charitable: Yes
Religious: No
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 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 LAILI ABD LATIF
Signature Title PRESIDENT
Signature Date 3/7/18

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