FORM 1023-EZ for ROSIE S ANIMAL RESCUE INC

Field Data
EIN 86-2869784
Case Number EO-2021161-000279
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ROSIE S ANIMAL RESCUE INC
Organization’s Mailing Address 10700 RED BARN LANE
City POTOMAC
State HI
ZIP 20854
Accounting period End 2
Primary contact name DERRICK QUAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHELE WALDMAN
DIRECTOR
10700 RED BARN LANE
POTOMAC MD 20854

Officer/Director/Trustee Two

DERRICK QUAN
DIRECTOR
2389 30TH AVENUE
SAN FRANCISCO CA 94116

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/11/2021
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
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 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 DERRICK QUAN
Signature Title DIRECTOR
Signature Date 6/8/2021

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