FORM 1023-EZ for NORTHWEST SPINE FOUNDATION
| Field | Data |
|---|---|
| EIN | 45-3069216 |
| Case Number | EO-2017233-000340 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | NORTHWEST SPINE FOUNDATION |
| Organization’s Mailing Address | 5 CENTERPOINT DRIVE SUITE 400 |
| City | LAKE OSWEGO |
| State | OR |
| ZIP | 97035 |
| Accounting period End | 12 |
| Primary contact name | JASON GONG |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JASON GONG
PRESIDENT DIRECTOR
5 CENTERPOINT DRIVE SUITE 400
LAKE OSWEGO OR 97035
Officer/Director/Trustee Two
ROBERT TATSUMI
SECRETARY DIRECTOR
19255 SW 65TH AVE SUITE 200
TUALATIN OR 97062
Officer/Director/Trustee Three
GEORGE OJI
DIRECTOR
9900 SE SUNNYSIDE ROAD
CLACKAMAS OR 97015
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | No |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/1/2008 |
| Organization Incorporation State | OR |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | H9B - Surgery Research |
| 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 | No |
| One Third Support Gifts | Yes |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | Yes |
| Correctness Declaration | Yes |
| Signature Name | |
| Signature Title | |
| Signature Date |
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