FORM 1023-EZ for KSVU 90 1 FM COMMUNITY RADIO

Field Data
EIN 84-4168919
Case Number EO-2020008-000205
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KSVU 90 1 FM COMMUNITY RADIO
Organization’s Mailing Address 7838 SOUTH SUPERIOR AVENUE
City CONCRETE
State WA
ZIP 98237
Accounting period End 12
Primary contact name BRYAN MELLOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRYAN MELLOR
PRESIDENT
1911 7TH STREET
SEDRO WOOLLEY WA 98284

Officer/Director/Trustee Two

DONNARAE BROCKMANN
VICE PRESIDENT
38834 STATE ROUTE 20
CONCRETE WA 98237

Officer/Director/Trustee Three

LINDEN JORDAN
SECRETARY
60793 DEXTER LANE
MARBLEMOUNT WA 98267

Officer/Director/Trustee Four

SALLY PFEIFER
TREASURER
7472 PRESSENTIN RANCH DRIVE
CONCRETE WA 98237

Organization’s website KSVU.ORG
Organization’s email KSVU90.1FM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/2/2020
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A34 - Radio
Organization’s purpose Charitable: No
Religious: Yes
Educational: Yes
Scientific: Yes
Literary: Yes
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 BRYAN MELLOR
Signature Title PRESIDENT
Signature Date 1/6/2020

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