FORM 1023-EZ for INTEGRATIVE MEDICINE GROUP

Field Data
EIN 82-0677808
Case Number EO-2017081-000126
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name INTEGRATIVE MEDICINE GROUP
Organization’s Mailing Address 8012 15TH AVE NW
City SEATTLE
State WA
ZIP 98117
Accounting period End 12
Primary contact name HENRI S VANDERHAGE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MASAHIRO TAKAKURA
DIRECTOR, PRESIDENT
7621 AURORA AVE N / UNIT A
SEATTLE WA 98103

Officer/Director/Trustee Two

CALVIN KWAN
DIRECTOR
803 SW TRENTON ST / UNIT B
SEATTLE WA 98106

Officer/Director/Trustee Three

DARCI DAVIS
DIRECTOR
2510 S HOLGATE ST UNIT B
SEATTLE WA 98144

Officer/Director/Trustee Four

GRACE CHANGE
SECRETARY
17512 83RD PL NE / UNIT B306
KENMORE WA 98028

Officer/Director/Trustee Five

TOM YANG
TREASURER
5020 157TH CT NE
REDMOND WA 98052

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/3/2017
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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