| Field | Data |
|---|---|
| EIN | 84-3587198 |
| Case Number | EO-2020269-000195 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | NORTHWEST INTERMOUNTAIN CONSORTIUMFOR PHYSICAL THERAPIST CLINICAL ED |
| Organization’s Mailing Address | 3107 IRIS AVENUE SUITE 100 |
| City | BOULDER |
| State | CO |
| ZIP | 80301-1915 |
| Accounting period End | 6 |
| Primary contact name | GREGORY J SMITH JD DBE |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
R JOE PALMER III PT DPT
CHAIR
13121 17TH AVENUE
AURORA CO 80045
JEREMY E HILLIARD PT DPT
VICE-CHAIR AND CHAIR-ELECT
222 SE 8TH AVENUE
HILLSBORO OR 97132
CARRIE GILLIS PT DPT
SECRETARY
4505 S MARYLAND PKWY BOX 453029
LAS VEGAS NV 89154-3029
MICHAEL BARTHOLOMEW PT DPT GCS
TREASURER
122 EAST 1700 SOUTH BUILDING 3
PROVO UT 84606
| Organization’s website | HTTPS://WWW.NICWEB.ORG/HOME |
|---|---|
| Organization’s email | JHILLIARD@PACIFICU.EDU |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 10/16/2019 |
| Organization Incorporation State | CO |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | B90 - Educational Services and Schools - Other |
| Organization’s purpose | Charitable: No 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 | R JOE PALMER III PT DPT |
| Signature Title | CHAIR |
| Signature Date | 9/23/2020 |
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