FORM 1023-EZ for THE PATIENT SAFETY LEAGUE
| Field | Data |
|---|---|
| EIN | 83-1412065 |
| Case Number | EO-2018242-000118 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | THE PATIENT SAFETY LEAGUE |
| Organization’s Mailing Address | 12155 MORRISON STREET |
| City | VALLEY VILLAGE |
| State | CA |
| ZIP | 91607 |
| Accounting period End | 12 |
| Primary contact name | ERIC ANDRIST |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
EDWARD HOLLINGSWORTH
PRESIDENT
9418 LA SUVIDA DR
LA MESA CA 91942
Officer/Director/Trustee Two
JEFFREY RIZZO
VICE PRESIDENT
12155 MORRISON STREET
VALLEY VILLAGE CA 91607
Officer/Director/Trustee Three
CURTIS THOMPSON
SECRETARY
12155 MORRISON STREET
VALLEY VILLAGE CA 90240
Officer/Director/Trustee Four
ERIC ANDRIST
TREASURER
12155 MORRISON STREET
VALLEY VILLAGE CA 91607
Officer/Director/Trustee Five
CURTIS THOMPSON
BOARD MEMBER
9135 CHANEY AVE
DOWNEY CA 90240
| Organization’s website | 4PATIENTSAFETY.ORG |
|---|---|
| Organization’s email | WEBMASTER@4PATIENTSAFETY.ORG |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 8/13/18 |
| Organization Incorporation State | CA |
| 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 | 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 | ERIC ANDRIST |
| Signature Title | TREASURER |
| Signature Date | 8/28/18 |
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