FORM 1023-EZ for OMNIMED INC

Field Data
EIN 37-1944693
Case Number EO-2019154-000501
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name OMNIMED INC
Organization’s Mailing Address 5059 HAWKS RIDGE DRIVE
City COLUMBUS
State GA
ZIP 31904-2043
Accounting period End 12
Primary contact name SHARVIL PATEL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHARVIL PATEL
CEO
5059 HAWKS RIDGE DRIVE
COLUMBUS GA 31904-2043

Officer/Director/Trustee Two

ELIZABETH SUN
COO
90 COTTONWOOD CIRCLE
ROLLING HILLS ESTATE CA 90274-3431

Officer/Director/Trustee Three

SIMON HE
CFO
105 VALLEY PLAZA
LANETT LA 36863-2075

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/11/19
Organization Incorporation State GA
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: 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 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 SHARVIL PATEL
Signature Title CEO
Signature Date 5/31/19

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