FORM 1023-EZ for PATIENTS FOR CHANGE
| Field | Data |
|---|---|
| EIN | 47-4517316 |
| Case Number | EO-2018262-000111 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | PATIENTS FOR CHANGE |
| Organization’s Mailing Address | 311 PRINCE ROYAL DRIVE |
| City | CORTE MADERA |
| State | CA |
| ZIP | 94925 |
| Accounting period End | 12 |
| Primary contact name | SUSAN WRIGHT |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
SUSAN WRIGHT
DIRECTOR
311 PRINCE ROYAL DRIVE
CORTE MADERA CA 94925
Officer/Director/Trustee Two
GORAN KOVOCEVIK
DIRECTOR
311 PRINCE ROYAL DRIVE
CORTE MADERA CA 94925
Officer/Director/Trustee Three
GLORIA STRIMPEL
DIRECTOR
311 PRINCE ROYAL DRIVE
CORTE MADERA CA 94925
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 7/7/15 |
| Organization Incorporation State | CA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P99 - Human Services - Multipurpose and Other N.E.C. |
| 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 | No |
| One Third Support Gifts | Yes |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | Yes |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | SUSAN WRIGHT |
| Signature Title | DIRECTOR |
| Signature Date | 9/17/18 |
| EIN | 47-4517316 |
| Case Number | EO-2015212-000358 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | PATIENTS FOR CHANGE |
| Organization’s Mailing Address | 311 PRINCE ROYAL DR |
| City | CORTE MADERA |
| State | CA |
| ZIP | 94925 |
| Accounting period End | 12 |
| Primary contact name | SUSAN WRIGHT |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $400.00 |
Officer/Director/Trustee One
GORAN KOVACEVIC
PRESIDENT, DIRECTOR
311 PRINCE ROYAL DR
CORTE MADERA CA 94925
Officer/Director/Trustee Two
SUSAN WRIGHT
SECRETARY, DIRECTOR
311 PRINCE ROYAL DR
CORTE MADERA CA 94925
Officer/Director/Trustee Three
HERMAN VANDERBERG
TREASURER, DIRECTOR
311 PRINCE ROYAL DR
CORTE MADERA CA 94925
Officer/Director/Trustee Four
TINA CELIS
DIRECTOR
311 PRINCE ROYAL DR
CORTE MADERA CA 94925
| Organization’s website | N/A |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 7/7/2015 |
| Organization Incorporation State | CA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P99 - Human Services - Multipurpose and Other N.E.C. |
| Organization’s purpose | Charitable: Yes 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 | 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 | 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 | |
| Signature Title | |
| Signature Date |
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