FORM 1023-EZ for REIMAGINE MEDICAL LAKE

Field Data
EIN 81-3799806
Case Number EO-2016256-000406
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name REIMAGINE MEDICAL LAKE
Organization’s Mailing Address PO BOX 344
City MEDICAL LAKE
State WA
ZIP 99022
Accounting period End 12
Primary contact name TERRI COOPER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BEN CABILDO
PRESIDENT
9910 S LAKEHURST DR
MEDICAL LAKE WA 99022

Officer/Director/Trustee Two

GERRILYN JOHNSON
VICE-PRESIDENT
5916 S BROOKS RD
MEDICAL LAKE WA 99022

Officer/Director/Trustee Three

JAN BAILEY
TREASURER
509 FAIRCHILD ST
MEDICAL LAKE WA 99022

Officer/Director/Trustee Four

MELISSA STRUTHERS
SECRETARY
509 S FAIRCHILD ST
MEDICAL LAKE WA 99022

Organization’s website HTTP://MEDICALLAKE.ORG
Organization’s email INFO@MEDICALLAKE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/4/2016
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
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 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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