FORM 1023-EZ for HEALTH ALLIES

Field Data
EIN 81-1161310
Case Number EO-2016043-000168
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEALTH ALLIES
Organization’s Mailing Address 7415 NORTH OATMAN
City PORTLAND
State OR
ZIP 97217
Accounting period End 12
Primary contact name TIFFANY KETTERMANN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TIFFANY KETTERMANN
CHIEF EXECUTIVE OFFICER, CIO
7415 NORTH OATMAN
PORTLAND OR 97217

Officer/Director/Trustee Two

REED PALMER
SECRETARY
1312 SW WASHINGTON ST
PORTLAND OR 97205

Officer/Director/Trustee Three

JORDAN HENDRICKSON
TREASURER
3310 SE DIVISION ST
PORTLAND OR 97202

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/12/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 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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