FORM 1023-EZ for ROTARY FOUNDATION OF GIG HARBOR NORTH CLUB

Field Data
EIN 47-1439194
Case Number EO-2014276-000217
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROTARY FOUNDATION OF GIG HARBOR NORTH CLUB
Organization’s Mailing Address PO BOX 1411
City GIG HARBOR
State WA
ZIP 98335
Accounting period End 12
Primary contact name JACOB L POTAK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PAUL MILLER
DIRECTOR
6720 PORT LANE
GIG HARBOR WA 98335

Officer/Director/Trustee Two

HEIDI HOLMES
DIRECTOR
7989 SCHOOLHOUSE AVE NW
GIG HARBOR WA 98335

Officer/Director/Trustee Three

KEN ROBERTS
DIRECTOR
5411 69TH ST CT NW
GIG HARBOR WA 98335

Officer/Director/Trustee Four

CONNIE ROSE
DIRECTOR
5775 SOUNDVIEW DR 203C
GIG HARBOR WA 98335

Officer/Director/Trustee Five

PATRICK WILLIAMS
DIRECTOR
10408 BUJACHICH
GIG HARBOR WA 98335

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/4/2014
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T31 - Community Foundations
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 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
Signature Title
Signature Date

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