FORM 1023-EZ for PATIENT SOLUTIONS INC

Field Data
EIN 37-1972940
Case Number EO-2021018-000210
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PATIENT SOLUTIONS INC
Organization’s Mailing Address 5244 SIERRA VILLA DR
City LOS ANGELES
State CA
ZIP 90041
Accounting period End 12
Primary contact name MATTHEW LISTIAK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MATTHEW LISTIAK
PRESIDENT
5244 SIERRA VILLA DR
LOS ANGELES CA 90041

Officer/Director/Trustee Two

KEITH MUSIL
TREASURER
1919 VINEBURN AVE G1
LOS ANGELES CA 90032

Officer/Director/Trustee Three

KIMBERLY ROGERS
SECRETARY
1919 VINEBURN AVE
LOS ANGELES CA 90032

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/15/2019
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A31 - Film, Video
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 Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More Yes
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
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 MATTHEW LISTIAK
Signature Title PRESIDENT
Signature Date 11/19/2020

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