FORM 1023-EZ for GREEN LANTERN LUNCH PROGRAM

Field Data
EIN 81-2990918
Case Number EO-2016265-000257
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GREEN LANTERN LUNCH PROGRAM
Organization’s Mailing Address PO BOX 443
City COPALLIS
State WA
ZIP 98535
Accounting period End 12
Primary contact name BILL CAMPBELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PHYLLIS SHAUGHNESSY
CHAIRMAN
PO BOX 411
COPALIS BEACH WA 98535

Officer/Director/Trustee Two

BILL CAMPBELL
DIRECTOR
PO BOX 205
MOCLIPS WA 98562

Officer/Director/Trustee Three

ED TEGENFELDT
DIRECTOR
PO BOX 303
PACIFIC BEACH WA 98571

Officer/Director/Trustee Four

GEORGE A LANDRUM
DIRECTOR
9100 ROOSEVELT WAY NE
SEATTLE WA 98115

Officer/Director/Trustee Five

CARRIE BALKEMA
DIRECTOR
9100 ROOSEVELT WAY NE
SEATTLE WA 98115

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/10/2016
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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 Yes
Donation of funds Yes
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
Signature Title
Signature Date

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