| Field | Data |
|---|---|
| EIN | 83-0887668 |
| Case Number | EO-2018225-000187 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | PACIFIC NORTHWEST WILDERNESS MEDICINE |
| Organization’s Mailing Address | 3181 SW SAM JACKSON PK RD / CDW-EM |
| City | PORTLAND |
| State | OR |
| ZIP | 97239 |
| Accounting period End | 12 |
| Primary contact name | FORREST WELLS |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
FORREST WELLS
BOARD PRESIDENT
3336 SE 15TH AVE
PORTLAND OR 97202
CRAIG WARDEN
BOARD TREASURER
3181 SW SAM JACKSON PK RD / CDW-EM
PORTLAND OR 97239
MILES MCDONOUGH
BOARD SECRETARY
5203 38TH AVE NE
SEATTLE WA 98105
CASSANDRA LOWRY EDMARK
BOARD VICE-PRESIDENT
4421 145TH PL SW
LYNNWOOD WA 98087
ANDREW LUKS
BOARD MEMBER AT LARGE
325 NINTH AVE / BOX 359762
SEATTLE WA 98104
| Organization’s website | WWW.PNWMED.ORG |
|---|---|
| Organization’s email | PNWMBOARD@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/20/18 |
| Organization Incorporation State | OR |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | B60 - Adult, Continuing Education |
| Organization’s purpose | Charitable: No 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 | Yes |
| One Third Support Gifts | No |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | FORREST WELLS |
| Signature Title | BOARD PRESIDENT |
| Signature Date | 8/9/18 |
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