FORM 1023-EZ for OLYMPIC PENINSULA HEALTHY COMMUNITYCOALITION

Field Data
EIN 81-3318669
Case Number EO-2017058-000849
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name OLYMPIC PENINSULA HEALTHY COMMUNITYCOALITION
Organization’s Mailing Address PO BOX 501
City CARLSBORG
State WA
ZIP 98324
Accounting period End 12
Primary contact name ANDRA SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MONICA DIXON
PRESIDENT
534 E RUNNION
SEQUIM WA 98382

Officer/Director/Trustee Two

MICHELLE RHODES
VICE PRESIDENT
21 W COBBLESTONE
SEQUIM WA 98382

Officer/Director/Trustee Three

ANDRA SMITH
SECRETARY
343 FOX HOLLOW ROAD
SEQUIM WA 98382

Officer/Director/Trustee Four

KERRY WYMAN-WEBB
TREASURER
300 WEBB RD
SEQUIM WA 98382

Officer/Director/Trustee Five

MARK OZIAS
POLICY ADVISOR
1605 HAPPY VALLEY ROAD
SEQUIM WA 98382

Organization’s website HEALTHYOP.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/21/2016
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
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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