FORM 1023-EZ for PHYSICIANS FOR POTS

Field Data
EIN 84-4001014
Case Number EO-2019364-000276
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PHYSICIANS FOR POTS
Organization’s Mailing Address 138 TROUT RUN MEWS WEST
City MEDIA
State PA
ZIP 19063
Accounting period End 12
Primary contact name DONALD J WEISS ESQUIRE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL GOODKIN
PRESIDENT
138 TROUT RUN MEWS WEST
MEDIA PA 19063

Officer/Director/Trustee Two

JOSHUA HOLLAND
BOARD MEMBER
235 HUCKLEBERRY HILLS LANE
TUSCUMBA AL 35674

Officer/Director/Trustee Three

BROOKE JEFFREY
BOARD MEMBER
2976 BELLA DRIVE
CONCORD CA 94519

Officer/Director/Trustee Four

PETER ROWE
BOARD MEMBER
200 N WOLF ST RM 2077
BALTIMORE MD 21287

Officer/Director/Trustee Five

ALISSA GOODKIN
BOARD MEMBER
138 TROUT RUN MEWS WEST
MEDIA PA 19063

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/11/2019
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
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 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 MICHAEL GOODKIN
Signature Title PRESIDENT
Signature Date 12/27/2019

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