FORM 1023-EZ for PORTLAND CURATIVE COLLECTIVE INCORPORATED

Field Data
EIN 47-4724233
Case Number EO-2015251-000153
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PORTLAND CURATIVE COLLECTIVE INCORPORATED
Organization’s Mailing Address 3609 SE CENTER ST
City PORTLAND
State OR
ZIP 97202
Accounting period End 12
Primary contact name TOM KLEIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TOM KLEIN
TREASURER
3609 SE CENTER ST
PORTLAND OR 97202

Officer/Director/Trustee Two

ROBIN LIEBERMAN
PRESIDENT
6502 SW BARNES RD
PORTLAND OR 97225

Officer/Director/Trustee Three

KELLY HOGAN
SECRETARY
5908 SE HILL ST
PORTLAND OR 97222

Officer/Director/Trustee Four

PABLO FELIZ
DIRECTOR
37516 MARYS RIVER RD
BLODGETT OR 97326

Officer/Director/Trustee Five

ERIC NIELSON
DIRECTOR
22345 S POPLAR RD
ESTACADA OR 97023

Organization’s website
Organization’s email CAMPHILL.INSPIRED.PDX@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/3/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P82 - Developmentally Disabled Centers, Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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
Signature Title
Signature Date

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