FORM 1023-EZ for PEACEFUL WARRIOR NEUROFEEDBACK INC

Field Data
EIN 82-1800584
Case Number EO-2017184-000218
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PEACEFUL WARRIOR NEUROFEEDBACK INC
Organization’s Mailing Address 419 CENTER ST STE 206
City OREGON CITY
State OR
ZIP 97045-2211
Accounting period End 12
Primary contact name ANDREA PREMAZZI-BAUER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREA PREMAZZI-BAUER
DIRECTOR/PRESIDENT
28840 SE WOODS RD
EAGLE CREEK OR 97022-9672

Officer/Director/Trustee Two

MELANIE BAILLIE
DIRECTOR
9185 N FINUCANE DR
HAYDEN ID 83835-9054

Officer/Director/Trustee Three

ZORA DEGRANDPRE
DIRECTOR
10886 US HIGHWAY 12
RANDLE WA 98377-9101

Officer/Director/Trustee Four

RON BAUER
TREASURER/SECRETARY
28840 SE WOODS RD
EAGLE CREEK OR 97022-9672

Organization’s website PEACEFULWARRIORNEUROFEEDBACK.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/16/2017
Organization Incorporation State OR
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: 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 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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