FORM 1023-EZ for JERRY ADAMS AQUATICS RESILIENCE PROGRAM
| Field | Data |
|---|---|
| EIN | 84-2728429 |
| Case Number | EO-2019316-000034 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | JERRY ADAMS AQUATICS RESILIENCE PROGRAM |
| Organization’s Mailing Address | 89325 OLD COBURG ROAD APARTMENT 309 |
| City | EUGENE |
| State | OR |
| ZIP | 97408 |
| Accounting period End | 12 |
| Primary contact name | DAVID E ATKIN |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JARROD BUTLER
PRESIDENT
78381 BIGELOW WAY
COTTAGE GROVE OR 97424
Officer/Director/Trustee Two
AMBER BUTLER
SECRETARY
78381 BIGELOW
COTTAGE GROVE OR 97424
Officer/Director/Trustee Three
VANESSA RENEE RINGOLD
TREASURER
3945 ROBIN AVENUE
EUGENE OR 97402
Officer/Director/Trustee Four
KENT MCINTOSH
DIRECTOR
5185 W AMAZON
EUGENE OR 97405
Officer/Director/Trustee Five
RICHARD DUSTIN JESSUP
DIRECTOR
640 SPYGLASS DRIVE
EUGENE OR 97401
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 7/16/19 |
| Organization Incorporation State | OR |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P80 - Services to Promote the Independence of Specific Populations |
| 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 | Yes |
| 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 | AMBER BUTLER |
| Signature Title | SECRETARY |
| Signature Date | 11/7/19 |
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