FORM 1023-EZ for NORTHWEST PERIOPERATIVE CONSORTIUM

Field Data
EIN 10-0964937
Case Number EO-2017104-000250
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NORTHWEST PERIOPERATIVE CONSORTIUM
Organization’s Mailing Address 221 FIRST AVE WEST STE 110
City SEATTLE
State WA
ZIP 98119-4223
Accounting period End 12
Primary contact name JUDITH ANDREWS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LESLIE GRIFFITH
PRESIDENT
1124 COLUMBIA STREET
SEATTLE WA 98104

Officer/Director/Trustee Two

DIANE MASIN
TREASURER
1035 116TH AVE NE
BELLEVUE WA 98004

Officer/Director/Trustee Three

KATHLEEN SMITH
LEGAL AFFAIR LEISON
209 MKL JR WAY
TACOMA WA 98405

Officer/Director/Trustee Four

HEATHER OWEN
BOARD MEMBER
1959 NE PACIFIC STREET
SEATTLE WA 98195-6115

Officer/Director/Trustee Five

DEENA GUREN
DIRECTOR
1959 NE PACIFIC STREET
SEATTE WA 98195-6118

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/9/2011
Organization Incorporation State WA
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: Yes
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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