FORM 1023-EZ for INLAND EMPOWER DERBY

Field Data
EIN 36-4802878
Case Number EO-2015082-000392
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name INLAND EMPOWER DERBY
Organization’s Mailing Address 2823-N-MEDLIA-ST
City SPOKANE
State WA
ZIP 99207
Accounting period End 12
Primary contact name JENNA CARROLL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JENNIFER MAYERNIK
PRESDIENT
13215 E NIXON
SPOKANE VALLEY WA 99216

Officer/Director/Trustee Two

JENNA CARROLL
VICE PRESDIENT
7808 N MORTON APT 788
SPOKANE WA 99208

Officer/Director/Trustee Three

JESSI BARTHOLOMEW
TREASURE
114 W COURTLAND
SPOKANE WA 99205

Officer/Director/Trustee Four

SAMANTHA GATTS
SECRETARY
1315 E BITTEROOT CT
DEAR PARK WA 99006

Organization’s website HTTP://WWW.IEDERBY.COM
Organization’s email SPOKANEDERBY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/18/2015
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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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