FORM 1023-EZ for INTENTIONAL HEALTH ORGANIZATION
| Field | Data |
|---|---|
| EIN | 84-4384510 |
| Case Number | EO-2020024-000249 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | INTENTIONAL HEALTH ORGANIZATION |
| Organization’s Mailing Address | 16055 SW WALKER RD NUM 401 PMB OR |
| City | BEAVERTON |
| State | OR |
| ZIP | 97006 |
| Accounting period End | 12 |
| Primary contact name | LAURA CHURCHMAN |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
LAURA CHURCHMAN
CEO
16055 SW WALKER RD
BEAVERTON OR 97006
Officer/Director/Trustee Two
TIMOTHY CHURCHMAN
CHIEF OF OPPORATIONS
16055 SW WALKER RD
BEAVERTON OR 97006
Officer/Director/Trustee Three
MARY OLSON
MEDICAL DIRECTOR
16055 SW WALKER RD
BEAVERTON OR 97006
| Organization’s website | WWW.INTENTIONALHEALTHORGANIZATION.COM |
|---|---|
| Organization’s email | IHOCONNECT@YAHOO.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 9/30/2019 |
| Organization Incorporation State | OR |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E70 - Public Health Program (Includes General Health and Wellness Promotion Services) |
| Organization’s purpose | Charitable: Yes Religious: Yes 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 | LAURA CHURCHMAN |
| Signature Title | CEO |
| Signature Date | 1/22/2020 |
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