FORM 1023-EZ for PATIENTS OF UKRAINE INC

Field Data
EIN 46-5283387
Case Number EO-2015103-000281
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PATIENTS OF UKRAINE INC
Organization’s Mailing Address 544 TWIN LAKES RD
City SHOHOLA
State PA
ZIP 18458-2614
Accounting period End 12
Primary contact name PETER STALEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PETER STALEY
PRESIDENT
544 TWIN LAKES RD
SHOHOLA PA 18458-2614

Officer/Director/Trustee Two

DANIEL WOLFE
TREASURER
544 TWIN LAKES RD
SHOHOLA PA 18458-2614

Officer/Director/Trustee Three

DAVID BARR
SECRETARY
544 TWIN LAKES RD
SHOHOLA PA 18458-2614

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/24/2014
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G01 - Alliance/Advocacy Organizations
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 Yes
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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