FORM 1023-EZ for OPERATION FULL BELLY

Field Data
EIN 81-1238208
Case Number EO-2016029-000357
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name OPERATION FULL BELLY
Organization’s Mailing Address 15231 SE SHALE DR
City DAMASCUS
State OR
ZIP 97089
Accounting period End 12
Primary contact name RACHAEL YOST
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RACHAEL YOST
PRESIDENT
15231 SE SHALE DRIVE
DAMASCUS OR 97089

Officer/Director/Trustee Two

SARAH HENDERSON
SECRETARY
17905 SE ARISTA DR
MILWAUKIE OR 97267

Officer/Director/Trustee Three

SHAMCI STANTON
TREASURER
12930 SE 51ST AVE
MILWAUKIE OR 97222

Officer/Director/Trustee Four

CHRIS JANSSEN
VICE PRESIDENT
5871 BONITA
LAKE OSWEGO OR 97035

Organization’s website
Organization’s email OPERATIONFULLBELLY@OUTLOOK.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/15/2016
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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 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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