FORM 1023-EZ for HIGH COUNTRY LACTATION CARE INC

Field Data
EIN 84-2569291
Case Number EO-2019234-000303
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HIGH COUNTRY LACTATION CARE INC
Organization’s Mailing Address 401 W ASPEN AVE
City FLAGSTAFF
State AZ
ZIP 86001
Accounting period End 12
Primary contact name PAULA PELLETIER-BUTLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PAULA PELLETIER-BUTLER
PRESIDENT
401 W ASPEN AVE
FLAGSTAFF AZ 86001

Officer/Director/Trustee Two

MAYA RADOCCIA-KENNEN
VP AND TREASURER
PO BOX 225
CLARKDALE AZ 86324

Officer/Director/Trustee Three

DANIKA DANKER
SECRETARY
1323 E HATCHER DRIVE
FLAGSTAFF AZ 86001

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/31/19
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B99 - Education N.E.C.
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 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 PAULA PELLETIER-BUTLER
Signature Title PRESIDENT
Signature Date 8/20/19

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