FORM 1023-EZ for COUCH FILM COLLECTIVE

Field Data
EIN 81-4378912
Case Number EO-2017026-000086
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COUCH FILM COLLECTIVE
Organization’s Mailing Address 940 NE ONEONTA ST
City PORTLAND
State OR
ZIP 97211-4072
Accounting period End 12
Primary contact name THEORA MOENCH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

THEORA MOENCH
PRESIDENT
6411 NE ALBINA AVE APT 5
PORTLAND OR 97217-1800

Officer/Director/Trustee Two

EVA MOSS
VICE-PRESIDENT
940 NE ONEONTA ST
PORTLAND OR 97211-4072

Officer/Director/Trustee Three

EVA MOSS
TREASURER
940 NE ONEONTA ST
PORTLAND OR 97211-4072

Officer/Director/Trustee Four

DAWN MACLEOD
VICE-PRESIDENT
17520 NW AUTUMN RIDGE DR
BEAVERTON OR 97006-4063

Officer/Director/Trustee Five

DAWN MACLEOD
SECRETARY
17520 NW AUTUMN RIDGE DR
BEAVERTON OR 97006-4063

Organization’s website WWW.COUCHCOLLECTIVE.ORG
Organization’s email COUCHCOLLECTIVEPDX@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/11/2016
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A31 - Film, Video
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 Yes
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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