FORM 1023-EZ for FIBRO PATIENT EDUCATION AND SUPPORTORGANIZATION

Field Data
EIN 47-2484791
Case Number EO-2015072-000617
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FIBRO PATIENT EDUCATION AND SUPPORTORGANIZATION
Organization’s Mailing Address 105 EAST TOWNLINE ROAD STE 128
City VERNON HILLS
State IL
ZIP 60061
Accounting period End 12
Primary contact name NECIE EDWARDS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NECIE EDWARDS
PRESIDENT/DIRECTOR
19 LINDON LANE
VERNON HILLS IL 60061

Officer/Director/Trustee Two

ANTHONY BOOTHE
VICE PRESIDENT
4603 36TH AVENUE APT 3
KENOSHA WI 53144

Officer/Director/Trustee Three

MICHELLE MORRIS
TREASURER
5225 43RD AVE
KENOSHA WI 53144

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/23/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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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