FORM 1023-EZ for PATIENT WELL-BEING FOUNDATION INC

Field Data
EIN 47-3678796
Case Number EO-2015128-000470
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PATIENT WELL-BEING FOUNDATION INC
Organization’s Mailing Address 4438 TWIN PINES DRIVE
City MANLIUS
State NY
ZIP 13104
Accounting period End 12
Primary contact name TIMOTHY KILPATRICK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT TEAGUE
VICE PRESIDENT
311 BOWIE STREET APT 1813
AUSTIN TX 78703

Officer/Director/Trustee Two

ROBERT EMMET KENNEY
TREASURER
1866 NW 127TH AVE
PEMBROKE PINES FL 33028

Officer/Director/Trustee Three

AYOOLA KALEJAIYE
SECRETARY
1013 PETER CHRISTIAN CIRCLE
CORONA CA 92881

Officer/Director/Trustee Four

TIMOTHY KILPATRICK
CEO AND PRESIDENT
4438 TWIN PINES DRIVE
MANLIUS NY 13104

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/10/2015
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H05 - Research Institutes and/or Public Policy Analysis
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 No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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
Signature Title
Signature Date

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