FORM 1023-EZ for ACDIS NW

Field Data
EIN 38-3868030
Case Number EO-2017097-000425
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ACDIS NW
Organization’s Mailing Address 5116 NORMA CT SE
City SALEM
State OR
ZIP 97306
Accounting period End 12
Primary contact name KAREN GRAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KAREN GRAY
TREASURER
5116 NORMA CT SE
SALEM OR 97306

Officer/Director/Trustee Two

MOLLY SEIBERT
PRESIDENT
1202SE EVANS LOOP
TROUTDALE OR 97060

Officer/Director/Trustee Three

LINDA DAWSON
SECRETARY
2419 SW CRESTWOOD PL
DALLAS OR 97338

Officer/Director/Trustee Four

MERYL MC CARTHY
BOARD MEMBER AT LARGE
1110 NE 10TH AVE
VANCOUVER WA 98644

Officer/Director/Trustee Five

COLEEN ELSER
BOARD MEMBER AT LARGE
10613 MILL CREEK RD SE
AUMSVILLE OR 97325

Organization’s website
Organization’s email ACDISNW@GMAIL.OM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/22/2017
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E03 - Professional Societies, Associations
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
Signature Title
Signature Date

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