FORM 1023-EZ for PARTNERS IN CARE NETWORK

Field Data
EIN 86-1503764
Case Number EO-2021123-000140
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PARTNERS IN CARE NETWORK
Organization’s Mailing Address 2112 F STREET 504
City WASHINGTON
State DC
ZIP 20037
Accounting period End 12
Primary contact name AQUILA CHISOLM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AUDREY WHETSELL
DIRECTOR
4922 DATE PALM DRIVE
CHARLESTON SC 29418

Officer/Director/Trustee Two

JOHN DEMBROWSKI
PRESIDENT
3301 NEW MEXICO AVE NW SUITE 346
WASHINGTON DC 20016

Officer/Director/Trustee Three

GARCIA WILLIAMS
SECRETARY
3035 BUCKELEY CIRCLE
CHARLESTON SC 29414

Officer/Director/Trustee Four

AARTI SUBRAMANIAN
REGISTERED AGT & TRUSTEE
4228 WISCONSIN AVE NW
WASHINGTON DC 20016

Officer/Director/Trustee Five

ROBERT COFFEY
TREASURER
4000 CATHEDRAL AVENUE NW STE 708B
WASHINGTON DC 20016

Organization’s website WWW.PICN.HEALTH
Organization’s email AWHETSELL@CONSULTRP.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/23/2020
Organization Incorporation State DC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
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 Yes
Donation of funds Yes
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name AUDREY WHETSELL
Signature Title DIRECTOR
Signature Date 4/29/2021

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