FORM 1023-EZ for SMITH ROCK WATER POLO CLUB

Field Data
EIN 82-5440998
Case Number EO-2018152-000236
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SMITH ROCK WATER POLO CLUB
Organization’s Mailing Address 2935 SW DESCHUTES DR
City REDMOND
State OR
ZIP 97756
Accounting period End 12
Primary contact name MELISSA CRISPEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MELISSA CRISPEN
PRESIDENT
2935 SW DESCHUTES DR
REDMOND OR 97756

Officer/Director/Trustee Two

KIMBERLY KAWELMACHER
TREASURER
994 ANGUS LN
TERREBONNE OR 97760

Officer/Director/Trustee Three

ANNA BREITLING
SECRETARY
PO BOX 1881
REDMOND OR 97756

Organization’s website WWW.SRWPC.COM
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/5/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N67 - Swimming, Water Recreation
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 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 MELISSA CRISPEN
Signature Title PRESIDENT
Signature Date 5/30/18

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