FORM 1023-EZ for PACIFIC NORTHWEST NEUROPSYCHOLOGICAL SOCIETY

Field Data
EIN 38-4159324
Case Number EO-2021217-000180
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PACIFIC NORTHWEST NEUROPSYCHOLOGICAL SOCIETY
Organization’s Mailing Address 22517 7TH AVE S
City DES MOINES
State WA
ZIP 98198
Accounting period End 12
Primary contact name JUDITH ANDREWS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MYRON GOLDBERG
PRESIDENT
3036 47TH AVE SW
SEATTLE WA 98116

Officer/Director/Trustee Two

EMILY TRITTSCHUH
VICE PRESIDENT
3057 36TH AVE SW
SEATTLE WA 98126

Officer/Director/Trustee Three

BRAD POWELL
SECRETARY
5638 71ST WAY NE
OLYMPIA WA 98516

Officer/Director/Trustee Four

PAUL CONNOR
TREASURER
20205 2ND AVE SW
NORMANDY PARK WA 98166

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/15/2020
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G96 - Neurology, Neuroscience
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 PAUL CONNOR
Signature Title TREASURER
Signature Date 8/3/2021

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