FORM 1023-EZ for PALMETTO AMPUTEE NETWORK

Field Data
EIN 82-4299270
Case Number EO-2018179-000366
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PALMETTO AMPUTEE NETWORK
Organization’s Mailing Address 626 ASPEN ST
City FLORENCE
State SC
ZIP 29501
Accounting period End 12
Primary contact name ANGEL OBRIEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANGEL OBRIEN
DIRECTOR
626 ASPEN ST
FLORENCE SC 29501

Officer/Director/Trustee Two

PATRICK OBRIEN
CEO
626 ASPEN ST
FLORENCE SC 29501

Officer/Director/Trustee Three

IVAN CHERNEV
CO-CEO
1925 HOFFMEYER RD
FLORENCE SC 29501

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/12/18
Organization Incorporation State SC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P01 - 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 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 ANGEL OBRIEN
Signature Title DIRECTOR
Signature Date 6/26/18

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