FORM 1023-EZ for HEALTHY FERRY COUNTY COALITION

Field Data
EIN 83-4461507
Case Number EO-2019164-000144
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALTHY FERRY COUNTY COALITION
Organization’s Mailing Address PO BOX 355
City KELLER
State WA
ZIP 99140-355
Accounting period End 12
Primary contact name SCOTT R SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERRY TITMUS
BOARD MEMBER
956 S MAIN STREET SUITE 1
COLVILLE WA 99114

Officer/Director/Trustee Two

DAVID NIELSEN
BOARD MEMBER
165 E HAWTHORNE AVE
COLVILLE WA 99114

Officer/Director/Trustee Three

AARON EDWARDS
BOARD MEMBER
36 KLONDIKE RD
REPUBLIC WA 99166

Officer/Director/Trustee Four

MATT SCHANZ
BOARD MEMBER
240 E DOMINION AVE
COLVILLE WA 99114

Officer/Director/Trustee Five

DAVID IVERSON
BOARD MEMBER
PO BOX 355
KELLER WA 99140

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/2/19
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S21 - Community Coalitions
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 DAVID IVERSON
Signature Title BOARD MEMBER
Signature Date 6/11/19

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