FORM 1023-EZ for PORTLAND ADVENTIST ACADEMY COUGAR BOOSTER CLUB

Field Data
EIN 81-3567331
Case Number EO-2016232-000442
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PORTLAND ADVENTIST ACADEMY COUGAR BOOSTER CLUB
Organization’s Mailing Address 10884 SE LENORE ST
City HAPPY VALLEY
State OR
ZIP 97086
Accounting period End 6
Primary contact name BRIAN IRVINE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRIAN IRVINE
PRESIDENT
10884 SE LENORE
HAPPY VALLEY OR 97086

Officer/Director/Trustee Two

CONRAD SLABBERT
VICE PRESIDENT
11031 SE TROIKA AVENUE
HAPPY VALLEY OR 97086

Officer/Director/Trustee Three

DEVI PETERSEN
TREASURE
18722 SE RICHEY ROAD
GRESHAM OR 97080

Officer/Director/Trustee Four

TAMBERLY COUCH
SECRETARY
12925 SW VILLAGE PARK LANE
TIGARD OR 97223

Officer/Director/Trustee Five

GINGER STINSON
COMMITTEES
850 NW 8TH ST
GRESHAM OR 97030

Organization’s website
Organization’s email PAACOUGARBOOSTER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/16/2016
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
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 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
Signature Title
Signature Date

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