FORM 1023-EZ for NICU FAMILIES NORTHWEST

Field Data
EIN 81-2029924
Case Number EO-2016235-000505
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NICU FAMILIES NORTHWEST
Organization’s Mailing Address 233 NE 58TH AVENUE
City PORTLAND
State OR
ZIP 97213-3805
Accounting period End 12
Primary contact name ANNA DAVID
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANNA DAVID
PRESIDENT/TREASURER
233 NE 58TH AVE
PORTLAND OR 97213-3805

Officer/Director/Trustee Two

LAURA COWLEY-MARTINSON
SECRETARY
5915 SE 22ND AVE
PORTLAND OR 97202-5239

Officer/Director/Trustee Three

EMILY TERRIQUEZ
BOARD MEMBER
5934 N ATLANTIC AVE
PORTLAND OR 97217-4018

Officer/Director/Trustee Four

ERIN REED
BOARD MEMBER
14727 SE WIND SONG PL
CLACKAMAS OR 97015-8474

Organization’s website
Organization’s email NICUFAMILIESNW@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/23/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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
Signature Title
Signature Date

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