FORM 1023-EZ for USA PATIENT NETWORK

Field Data
EIN 85-0983335
Case Number EO-2020139-000094
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name USA PATIENT NETWORK
Organization’s Mailing Address 510 STADLER LANE
City PETALUMA
State CA
ZIP 94952
Accounting period End 3
Primary contact name DRU WEST
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DRU WEST
PRESIDENT/CHAIRPERSON/DIRECTOR
510 STADLER LANE
PETALUMA CA 94952-1681

Officer/Director/Trustee Two

ANGIE FIRMALINO
TREASURER/DIRECTOR
PO BOX 309
TANNERSVILLE NY 12485-0309

Officer/Director/Trustee Three

BEVERLY JANE PENNINGTON
VICE PRESIDENT/DIRECTOR
747 CENTER POINT RD
CARROLLTON GA 30117-6773

Officer/Director/Trustee Four

JONATHAN FURMAN
SECRETARY/DIRECTOR
2839 WESTGATE DRIVE
RICHMOND VA 23235-2334

Officer/Director/Trustee Five

KIM WITCZAK
DIRECTOR
345 NORTH 6TH AVENUE APT 102
MINNEAPOLIS MN 55401-1757

Organization’s website USAPATIENTNETWORK.ORG
Organization’s email USAPATIENTNETWORK@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/10/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
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 Yes
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 DRU WEST
Signature Title PRESIDENT/CHAIRPERSON/DIRECTOR
Signature Date 5/13/2020

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