FORM 1023-EZ for BLACK PHYSICIANS NETWORK OF GREATERROCHESTER INC

Field Data
EIN 47-3192101
Case Number EO-2015098-000389
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLACK PHYSICIANS NETWORK OF GREATERROCHESTER INC
Organization’s Mailing Address PO BOX 23265
City ROCHESTER
State NY
ZIP 14692
Accounting period End 12
Primary contact name GINA CUYLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GINA CUYLER
DIRECTOR
399 COASTAL VIEW DRIVE
WEBSTER NY 14580

Officer/Director/Trustee Two

LINDA CLARK
DIRECTOR
237 RED HICKORY DRIVE
ROCHESTER NY 14626

Officer/Director/Trustee Three

NANANAMIBIA DUFFY
DIRECTOR
6 WARBLER LANE
WEST HENRIETTA NY 14586

Organization’s website WWW.BLACKPHYSICIANSNETWORK.ORG
Organization’s email BLACKPHYSICIANSNETWORK@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/19/2015
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code R03 - Professional Societies, Associations
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 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 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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