FORM 1023-EZ for IMPACT CARE ACCESS NETWORK II

Field Data
EIN 82-5184753
Case Number EO-2018128-000357
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name IMPACT CARE ACCESS NETWORK II
Organization’s Mailing Address 9390 HESPERIA ROAD SUITE 7
City HESPERIA
State CA
ZIP 92345
Accounting period End 12
Primary contact name ARSHAD M FAROOQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LANCE PETERS
EXECUTIVE DIRECTOR
9390 HESPERIA ROAD SUITE 7
HESPERIA CA 92345

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/11/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 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 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 LANCE PETERS
Signature Title EXECUTIVE DIRECTOR
Signature Date 4/30/18

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