FORM 1023-EZ for CASCADE STATE MEDICAL ASSOCIATION

Field Data
EIN 87-2541673
Case Number EO-2021259-000239
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CASCADE STATE MEDICAL ASSOCIATION
Organization’s Mailing Address 3088 SW FAIRMOUNT BLVD
City PORTLAND
State OR
ZIP 97239
Accounting period End 12
Primary contact name REVA RICKETTS-LORIAUX
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FRED WILLIAMS
PRESIDENT
17595 SW ALBERT CT
BEAVERTON OR 97007

Officer/Director/Trustee Two

MARIE THEARD
SECRETARY
3702 N BORTHWICK AVE
PORTLAND OR 97227

Officer/Director/Trustee Three

REVA RICKETTS-LORIAUX
ACTING TREASURER
3088 SW FAIRMOUNT BLVD
PORTLAND OR 97239

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/23/2021
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W03 - Professional Societies, Associations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 REVA RICKETTS-LORIAUX
Signature Title ACTING TREASURER
Signature Date 9/14/2021

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