FORM 1023-EZ for PROSTATE FORUM OF ORANGE COUNTY

Field Data
EIN 10-0916798
Case Number EO-2015065-000261
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PROSTATE FORUM OF ORANGE COUNTY
Organization’s Mailing Address 1429 NORTH PALM AVENUE
City UPLAND
State CA
ZIP 91786-2770
Accounting period End 12
Primary contact name LARRY BARMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RUSSELL THOMAS
CHAIRMAN/CEO
1429 NORTH PALM AVENUE
UPLAND CA 91786-2770

Officer/Director/Trustee Two

STEVE ADAMSON
VICE CHAIRMAN/VICE PRESIDENT
1253 WARREN STREET
PLACENTA CA 92870-3640

Officer/Director/Trustee Three

CHARLES GADBERRY
SCRETARY
6081 APACHE ROAD
WESTMINSTER CA 92683-1915

Officer/Director/Trustee Four

JOHN OLSSON
DIRECTOR
PO BOX 8476
NEWPORT BEACH CA 92658-8476

Officer/Director/Trustee Five

LARRY BARMAN
DIRECTOR
647 ALTA VISTA WAY
LAGUNA BEACH CA 92651-4040

Organization’s website HTTP://WWW.PROSTATEFORUM.ORG
Organization’s email PROSTATEFORUMOC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/3/2008
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G40 - Diseases of Specific Organs
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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