FORM 1023-EZ for PERIPHERAL NEUROPATHY SUPPORT NETWORK
| Field | Data |
|---|---|
| EIN | 87-2206445 |
| Case Number | EO-2021263-000796 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | PERIPHERAL NEUROPATHY SUPPORT NETWORK |
| Organization’s Mailing Address | 4311 DAHILL PL |
| City | ALEXANDRIA |
| State | VA |
| ZIP | 22312 |
| Accounting period End | 12 |
| Primary contact name | PATRICIA GUALTIERI |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
PATRICIA GUALTIERI
PRESIDENT
4311 DAHILL PL
ALEXANDRIA VA 22312
Officer/Director/Trustee Two
DAVID BUSH
NETWORK DEVELOPMENT CR
11776 STRATFORD HOUSE PLACE 3503
RESTON VA 20190
Officer/Director/Trustee Three
MICHAEL FOXWORTH
STRATEGIC PLANNER
11410 TURNMILL LANE
RESTON VA 20191
Officer/Director/Trustee Four
JUDSON VAUGHN
TECHNICAL DIRECTOR
12455 PLOWMAN COURT
HERNDON VA 20170
Officer/Director/Trustee Five
REBECCA HOTOP
TREASURER
10639 CANTERBERRY ROAD
FAIRFAX STATION VA 22039
| Organization’s website | DCPNSUPPORT.ORG |
|---|---|
| Organization’s email | |
| Organization Incorporated | No |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 9/18/2021 |
| Organization Incorporation State | VA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | G50 - Nerve, Muscle and Bone Diseases |
| 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 | 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 | PATRICIA GUALTIERI |
| Signature Title | PRESIDENT |
| Signature Date | 9/18/2021 |
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