Charitable Activities Section Oregon Department of Justice 3 No 3 No
Form
Charitable Activities Section Oregon Department of Justice
CT-12
1515 s w 5th Avenue, Suite 410 Portland, OR 97201-5451 Email: [email protected] Website: http://www.doj.state.or.us
For Oregon Charities
Section i.
For Accounting Periods Beginning in:
VOICE (971)673-1880 TTY (800) 735-2900 FAX (971)673-1882
2013
Generai information
1.
Cross Through Incorrect Items and Correct Here: (See instructions for change of name or accounting period.) Registration #: 42431 Organization Name: Dili Pickle Club dba Know Your City Address: 800 NW 6th Ave, #331 _
OF JUSTICE
City, state. Zip: Portland, OR 97209 Phone: 971-717-7307 Email: [email protected]
Fax:
Period Beginning: 0 1 / 01 /2013
PeriodEndIng:
Amended Report? 12/31
Did a certified public accountant audit your financial records? - If yes, attach a copy of the auditor's report, financial statements, accompanying notes, schedules, or other documents supplementing the report or financial statements.
/2013
n
is the organization a party to a contract involving person-to-person, advertising, vending machine or telephone fund-raising in Oregon? Ifyes, write the name ofthe fund-raising finn(s) who conducts the campaign(s):
•
Q
Yes
ves
Has the organization or any of its officers, directors, trustees, or key employees ever signed a voluntary agreement with any govemment agency, such as a state attomey general, secretary of state, or local district attomey, or been a party to legal action in any court or administrative agency regarding charitable solicitation, administration, management, or fiduciary practices? If yes, attach explanation of each such agreement or action. See instmctions.
•
During this reporting period, did the organization amend its articles of incorporation, bylaws, or trust documents, OR did the organization receive a determination letter from the Intemal Revenue Service relating to its tax-exempt status? Ifyes, attach a copy of the amended document or letter.
•
Yes
Is the organization ceasing operations and is this the final report? (If yes, see instructions on how to close your registration.)
•
Yes
^ N o
0 N O
Y e s 0 No
3 3
No No
Provide contact information for the person responsible for retaining the organization's records. Name
Position
Jesse Fisker
Treasurer
Phone 360-749-3009
Mailing Address & Email Address 800 NW 6th Ave, #331, Portland, OR 97209 [email protected]
List of Officers, Directors, Tmstees and Key Employees - List each person who held one of these positions at any time during the year even if they did not receive compensation. Attach additional sheets if necessary. If an attached IRS form includes substantially the same compensation infonnation, the phrase "See IRS Fomi" may be entered in lieu of completing that section. (Oregon law requires a minimum of three directors.) (A) Name, mailing address, daytime phone number and email address
Name: Address:
Marc Moscato 800 NW 6th Ave, #331, Portland, OR 97209
Phone:
( _ 9 7 1 _ ) 717-7307
Email: Name:
[email protected]
Address:
800 NW 6th Ave, #331, Portland, OR 97209
Phone:
( _ 9 7 1 _ ) 717-7307
Email: Name:
[email protected]
Address:
800 NW 6th Ave, #331, Portland, OR 97209
Phone:
( _ 9 7 1 _ ) 717-7307
Email:
[email protected]
Jesse Fisker
(B) Title & average weekly hours devoted to position Executive Director, 40 hrs/wk
(C) Compensation (enter $0 if position unpaid)
$29,936.00
Treasurer, 4 hrs/wk $0.00
Cameron Whitten
F o r m C o n t i n u e d on R e v e r s e S i d e
President, Board of Directors, 4 hrs/wk
$0.00
Section 11.
Fee Caicuiation
Total Revenue (From Line 12 (cunent year) on Fomi 990; Une 9 on Fomi 990-EZ; PartI, Line 12a on Form 990-PF; Line 9 on Fomn 1041; or s e e paga 3 of tiie instructions if no federal tax ratum was prepared. Attach explanation If Total Revenue Is $0.)
10.
$107,231.00
I 10.
Revenue Fee (See chart below. Minimum fee is $10, even if total revenue is a negative amount.) Revenue F e e Amount on Line 9 $24,999 $10 $0 $25 $49,999 $25,000 $99,999 $45 $50,000 $75 $249,999 $100,000 $100 $499,999 $250,000 $135 $749,999 $500,000 $170 $999,999 $750,000 $200 $1,000,000 or more
11.
Net Assets or Fund Balances at End ofthe Reporting Period....
11.
(From Line 22 (and of year) on Forni 990, Line 21 on Forni 990-EZ, or Part III, Line 6 on Fonn 990-PF; or see page 3 of CT-12 instructions to calculate.)
12.
Net Fixed Assets Used to Conduct Charitable Activities
$75.00
$9,631.00 I 12.
(Generally, from Part X, Line 10c on Fonn 990, Line 23B on Fomn 990-EZ or Part II, Line 14b on Fomi 990-PF; or see page 4 of CT-12 instructions to calculale. S e e instnjctions if organization owns income-producing.)
13.
13.
Amount Subject to Net Assets or Fund Balances Fee (Line 11 minus Une 12. If Una 11 minus Une 12 Is less ttian $50,000, write $0.)
14.
$0.00 I 14.
Net Assets or Fund Balances Fee
$0.00
(Una 13 multiplied by .0001. If the fee is less than $5, enter $0. Not to e x c e ed $1,000. Round cents to the nearest whole dollar.)
15.
Are you filing this report late? 0
Yes
O No
15. $100.00
(If yas, the late fee is a minimum of $20. You may owe more depending on how late the report is. S e e Instruction 15 for additional infomiation or contact the Charitable Activities Section at (971) 673-1880 to obtain late fee amount)
16.
16.
Total Amount Due
$175.00
(Add Unes 10,14, and 15. Make chedt payable to the Oregon Department of Justice.)
17.
Attach a copy of the organization's federal 990 or other retum and all supporting schedules and attachments that were filed with the IRS with the exception that Fonn 990 & 990EZ filers do not need to attach a copy of their Schedule B. Also, if the organization did not file with the IRS or filed a 990-N, but had Total Revenue of $25,000 or more, or Net Assets or Fund Balances of $50,000 or more, see the Instmctions as the organization may be required to complete certain IRS forms for Oregon purposes only. If the attached retum was not filed with the IRS, then mark any such retum as 'For Oregon Purposes Only." If your organization files IRS Fomn 990-N (e-Postcard) please attach a copy or confirmation of its filing
Please Sign Here Paid Preparer's U s e Only
Under penalties of perjury, I declare that I have examined this retum, including all accompanying forms, schedules, and attachments, and to the best of my knowletjae and belief, it is true, connect, and complete. 7/31/15 Date
Treasurer Title
Preparer's signature
Date
Phone
Preparer's name
Address
Board List: 2013 Lucy Rockwell Kyle Von Hoetzendorff BJ Thomsen Dale Davis Reiko Hillyer Cameron Whitten Kenan Ferrall Jesse Fisker Annie Fitzgerald Mike Gushard Jesse Fisker William Elder
Average weekly hours devoted to position
Compensation
Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4
hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Director, 4 hrs/wk
$0.00
Benjamin Gerritz
Director, 4 hrs/wk
$0.00
Reiko Hillyer Cameron Whitten Kenan Ferrall Jesse Fisker Annie Fitzgerald Mike Gushard Jesse Fisker William Elder
Director, Director, Director, Director, Director, Director, Director,
hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Director, 4 hrs/wk
$0.00
Benjamin Gerritz
Director, 4 hrs/wk
$0.00
2014 4 4 4 4 4 4 4
Charitable Activities Section Oregon Department of Justice
CT-12
1515 s w 5th Avenue, Suite 410 Portland, OR 97201-5451 Email: [email protected] Website: http://www.doj.state.or.us
For Oregon Charities
Section i.
For Accounting Periods Beginning in:
VOICE (971)673-1880 TTY (800) 735-2900 FAX (971)673-1882
2013
Generai information
1.
Cross Through Incorrect Items and Correct Here: (See instructions for change of name or accounting period.) Registration #: 42431 Organization Name: Dili Pickle Club dba Know Your City Address: 800 NW 6th Ave, #331 _
OF JUSTICE
City, state. Zip: Portland, OR 97209 Phone: 971-717-7307 Email: [email protected]
Fax:
Period Beginning: 0 1 / 01 /2013
PeriodEndIng:
Amended Report? 12/31
Did a certified public accountant audit your financial records? - If yes, attach a copy of the auditor's report, financial statements, accompanying notes, schedules, or other documents supplementing the report or financial statements.
/2013
n
is the organization a party to a contract involving person-to-person, advertising, vending machine or telephone fund-raising in Oregon? Ifyes, write the name ofthe fund-raising finn(s) who conducts the campaign(s):
•
Q
Yes
ves
Has the organization or any of its officers, directors, trustees, or key employees ever signed a voluntary agreement with any govemment agency, such as a state attomey general, secretary of state, or local district attomey, or been a party to legal action in any court or administrative agency regarding charitable solicitation, administration, management, or fiduciary practices? If yes, attach explanation of each such agreement or action. See instmctions.
•
During this reporting period, did the organization amend its articles of incorporation, bylaws, or trust documents, OR did the organization receive a determination letter from the Intemal Revenue Service relating to its tax-exempt status? Ifyes, attach a copy of the amended document or letter.
•
Yes
Is the organization ceasing operations and is this the final report? (If yes, see instructions on how to close your registration.)
•
Yes
^ N o
0 N O
Y e s 0 No
3 3
No No
Provide contact information for the person responsible for retaining the organization's records. Name
Position
Jesse Fisker
Treasurer
Phone 360-749-3009
Mailing Address & Email Address 800 NW 6th Ave, #331, Portland, OR 97209 [email protected]
List of Officers, Directors, Tmstees and Key Employees - List each person who held one of these positions at any time during the year even if they did not receive compensation. Attach additional sheets if necessary. If an attached IRS form includes substantially the same compensation infonnation, the phrase "See IRS Fomi" may be entered in lieu of completing that section. (Oregon law requires a minimum of three directors.) (A) Name, mailing address, daytime phone number and email address
Name: Address:
Marc Moscato 800 NW 6th Ave, #331, Portland, OR 97209
Phone:
( _ 9 7 1 _ ) 717-7307
Email: Name:
[email protected]
Address:
800 NW 6th Ave, #331, Portland, OR 97209
Phone:
( _ 9 7 1 _ ) 717-7307
Email: Name:
[email protected]
Address:
800 NW 6th Ave, #331, Portland, OR 97209
Phone:
( _ 9 7 1 _ ) 717-7307
Email:
[email protected]
Jesse Fisker
(B) Title & average weekly hours devoted to position Executive Director, 40 hrs/wk
(C) Compensation (enter $0 if position unpaid)
$29,936.00
Treasurer, 4 hrs/wk $0.00
Cameron Whitten
F o r m C o n t i n u e d on R e v e r s e S i d e
President, Board of Directors, 4 hrs/wk
$0.00
Section 11.
Fee Caicuiation
Total Revenue (From Line 12 (cunent year) on Fomi 990; Une 9 on Fomi 990-EZ; PartI, Line 12a on Form 990-PF; Line 9 on Fomn 1041; or s e e paga 3 of tiie instructions if no federal tax ratum was prepared. Attach explanation If Total Revenue Is $0.)
10.
$107,231.00
I 10.
Revenue Fee (See chart below. Minimum fee is $10, even if total revenue is a negative amount.) Revenue F e e Amount on Line 9 $24,999 $10 $0 $25 $49,999 $25,000 $99,999 $45 $50,000 $75 $249,999 $100,000 $100 $499,999 $250,000 $135 $749,999 $500,000 $170 $999,999 $750,000 $200 $1,000,000 or more
11.
Net Assets or Fund Balances at End ofthe Reporting Period....
11.
(From Line 22 (and of year) on Forni 990, Line 21 on Forni 990-EZ, or Part III, Line 6 on Fonn 990-PF; or see page 3 of CT-12 instructions to calculate.)
12.
Net Fixed Assets Used to Conduct Charitable Activities
$75.00
$9,631.00 I 12.
(Generally, from Part X, Line 10c on Fonn 990, Line 23B on Fomn 990-EZ or Part II, Line 14b on Fomi 990-PF; or see page 4 of CT-12 instructions to calculale. S e e instnjctions if organization owns income-producing.)
13.
13.
Amount Subject to Net Assets or Fund Balances Fee (Line 11 minus Une 12. If Una 11 minus Une 12 Is less ttian $50,000, write $0.)
14.
$0.00 I 14.
Net Assets or Fund Balances Fee
$0.00
(Una 13 multiplied by .0001. If the fee is less than $5, enter $0. Not to e x c e ed $1,000. Round cents to the nearest whole dollar.)
15.
Are you filing this report late? 0
Yes
O No
15. $100.00
(If yas, the late fee is a minimum of $20. You may owe more depending on how late the report is. S e e Instruction 15 for additional infomiation or contact the Charitable Activities Section at (971) 673-1880 to obtain late fee amount)
16.
16.
Total Amount Due
$175.00
(Add Unes 10,14, and 15. Make chedt payable to the Oregon Department of Justice.)
17.
Attach a copy of the organization's federal 990 or other retum and all supporting schedules and attachments that were filed with the IRS with the exception that Fonn 990 & 990EZ filers do not need to attach a copy of their Schedule B. Also, if the organization did not file with the IRS or filed a 990-N, but had Total Revenue of $25,000 or more, or Net Assets or Fund Balances of $50,000 or more, see the Instmctions as the organization may be required to complete certain IRS forms for Oregon purposes only. If the attached retum was not filed with the IRS, then mark any such retum as 'For Oregon Purposes Only." If your organization files IRS Fomn 990-N (e-Postcard) please attach a copy or confirmation of its filing
Please Sign Here Paid Preparer's U s e Only
Under penalties of perjury, I declare that I have examined this retum, including all accompanying forms, schedules, and attachments, and to the best of my knowletjae and belief, it is true, connect, and complete. 7/31/15 Date
Treasurer Title
Preparer's signature
Date
Phone
Preparer's name
Address
Board List: 2013 Lucy Rockwell Kyle Von Hoetzendorff BJ Thomsen Dale Davis Reiko Hillyer Cameron Whitten Kenan Ferrall Jesse Fisker Annie Fitzgerald Mike Gushard Jesse Fisker William Elder
Average weekly hours devoted to position
Compensation
Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4 Director, 4
hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Director, 4 hrs/wk
$0.00
Benjamin Gerritz
Director, 4 hrs/wk
$0.00
Reiko Hillyer Cameron Whitten Kenan Ferrall Jesse Fisker Annie Fitzgerald Mike Gushard Jesse Fisker William Elder
Director, Director, Director, Director, Director, Director, Director,
hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk hrs/wk
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Director, 4 hrs/wk
$0.00
Benjamin Gerritz
Director, 4 hrs/wk
$0.00
2014 4 4 4 4 4 4 4
