| Field | Data |
|---|---|
| EIN | 86-3681223 |
| Case Number | EO-2021193-000886 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | GOLDEN STATE MEDICAL ASSOCIATION |
| Organization’s Mailing Address | 4361 S WESTERN AVE |
| City | LOS ANGELES |
| State | CA |
| ZIP | 90062 |
| Accounting period End | 12 |
| Primary contact name | L KHADIJAH LANG |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
L KHADIJAH LANG MD
PRESIDENT
4361 S WESTERN AVE
LOS ANGELES CA 90062
ANNE STAVEREN MD
SECRETARY
4733 W SUNSET BLVD
LOS ANGELES CA 90027
JIMI BENSON MD
TREASURER
2401 REO DR
SAN DIEGO CA 92139
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/16/2019 |
| Organization Incorporation State | CA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | G03 - Professional Societies, Associations |
| 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 | Yes |
| Financial transactions with officers | No |
| Unrelated Gross Income $1,000 or More | No |
| Gaming Activity | No |
| Disaster relief assistance | Yes |
| 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 | L KHADIJAH LANG MD |
| Signature Title | PRESIDENT |
| Signature Date | 7/9/2021 |
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