FORM 1023-EZ for NORTHWEST NARRATIVE MEDICINE COLLABORATIVE

Field Data
EIN 82-5527793
Case Number EO-2018312-000092
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NORTHWEST NARRATIVE MEDICINE COLLABORATIVE
Organization’s Mailing Address PO BOX 231237
City PORTLAND
State OR
ZIP 97281
Accounting period End 12
Primary contact name ELIZABETH P LAHTI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ELIZABETH LAHTI
PRESIDENT
2496 SW ARDEN RD
PORTLAND OR 97201

Officer/Director/Trustee Two

KATHRYN LILJEHOLM
TREASURER
3802 SE 65TH AVE
PORTLAND OR 97206

Officer/Director/Trustee Three

ELLEN MICHAELSON
VICE PRESIDENT
2634 NE HALSEY STREET
PORTLAND OR 97232

Officer/Director/Trustee Four

REBECCA HARRISON
SECRETARY
2748 NE 19TH AVE
PORTLAND OR 97212

Officer/Director/Trustee Five

DAENA GOLDSMITH
BOARD MEMBER
21522 SW MARTINAZZI AVE
TUALITAN OR 97062

Organization’s website WWW.NWNMCOLLABORATIVE.ORG
Organization’s email NWNMC.PDX@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A70 - Humanities Organizations
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 Yes
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 ELIZABETH LAHTI
Signature Title PRESIDENT
Signature Date 11/5/18

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