FORM 1023-EZ for UMPQUA VALLEY BREW HUB

Field Data
EIN 47-4521019
Case Number EO-2015247-000080
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name UMPQUA VALLEY BREW HUB
Organization’s Mailing Address 328 SE JACKSON
City ROSEBURG
State OR
ZIP 97470
Accounting period End 12
Primary contact name JENNIFER OTOOLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JENNIFER OTOOLE
PRESIDENT
328 SE JACKSON
ROSEBURG OR 97470

Officer/Director/Trustee Two

ROBERT MCKIM
VICE PRESIDENT
165 CHAR ST
ROSEBURG OR 97471-4778

Officer/Director/Trustee Three

KC MCKILLIP
SECRETARY
1640 NE ODELL AVE
ROSEBURG OR 97470

Officer/Director/Trustee Four

CASEY OTOOLE
MEMBER
328 SE JACKSON
ROSEBURG OR 97470

Officer/Director/Trustee Five

SCOTT CHAPPELL
ADVISOR
3449 WEST HARVARD AVE
ROSEBURG OR 97471

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/7/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
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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