FORM 1023-EZ for AUXILIA HEALTH

Field Data
EIN 82-1149945
Case Number EO-2017131-000420
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AUXILIA HEALTH
Organization’s Mailing Address PO BOX 219098
City PORTLAND
State OR
ZIP 97225-9098
Accounting period End 12
Primary contact name DEREK NIX
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEREK NIX
FOUNDER
3945 SE GLADSTONE ST APT 6
PORTLAND OR 97202

Officer/Director/Trustee Two

ANDREW KEATING
CO-FOUNDER
4825 SW FRANKLIN AVE APT 237
BEAVERTON OR 97005

Organization’s website AUXILIAHEALTH.ORG
Organization’s email INFO@AUXILIAHEALTH.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/12/2017
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
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 Yes
Donation of funds Yes
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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