FORM 1023-EZ for MOUNTAIN VIEW HIGH SCHOOL HOSA BOOSTER CLUB

Field Data
EIN 83-2914384
Case Number EO-2019035-000102
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MOUNTAIN VIEW HIGH SCHOOL HOSA BOOSTER CLUB
Organization’s Mailing Address 17302 SE 23RD WAY
City VANCOUVER
State WA
ZIP 98683-3310
Accounting period End 6
Primary contact name KEVIN LO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEVIN LO
PRESIDENT
17302 SE 23RD WAY
VANCOUVER WA 98683-3310

Officer/Director/Trustee Two

ADELINE JOHNSON
VICE PRESIDENT
14517 SE 28TH ST
VANCOUVER WA 98683-7645

Officer/Director/Trustee Three

EVA HUANG
TREASURER
3705 SE 172ND AVE
VANCOUVER WA 98683-9457

Officer/Director/Trustee Four

DESSA WELLS
SECRETARY
804 NE 159TH CT
VANCOUVER WA 98684-8753

Officer/Director/Trustee Five

JEFF LATHROP
DIRECTOR
2507 SE BLAIRMONT DR
VANCOUVER WA 98683-8501

Organization’s website
Organization’s email MVHOSABOOSTER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/18
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
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 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 KEVIN LO
Signature Title PRESIDENT
Signature Date 1/15/19

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