FORM 1023-EZ for ROTACARE OF GREATER LOS ANGELES

Field Data
EIN 46-3377428
Case Number EO-2015016-000593
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROTACARE OF GREATER LOS ANGELES
Organization’s Mailing Address 6355 TOPANGA CANYON - SUITE 428
City WOODLAND HILLS
State CA
ZIP 91367-2140
Accounting period End 6
Primary contact name CHARLES CAMERON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GWYN PETRICK
PRESIDENT
375 LOIRE VALLEY DRIVE
SIMI VALLEY CA 93065

Officer/Director/Trustee Two

PHIL JOHNSON
SECRETARY
25814 ANDERSON LANE
STEVENSON RANCH CA 91381

Officer/Director/Trustee Three

CHARLES CAMERON
DIRECTOR
4449 BOSTON DRIVE
PLANO TX 75093

Officer/Director/Trustee Four

GAUTAM KUMAR
TREASURER
7138 SALE AVENUE
WESTHILLS CA 91307

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/5/2013
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - 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 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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