FORM 1023-EZ for PFTHS PARTNERS FOR TELEHEALTH SERVICES

Field Data
EIN 90-1074121
Case Number EO-2016270-000412
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PFTHS PARTNERS FOR TELEHEALTH SERVICES
Organization’s Mailing Address 9202 VENTURE CT SUITE 211
City MANASSAS PARK
State VA
ZIP 20111
Accounting period End 12
Primary contact name MICHAEL LEE JOHNSON SR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL LEE JOHNSON SR
PRESIDENT CEO
9202 VENTURE CT
MANASSAS PARKER VA 20111-8049

Officer/Director/Trustee Two

PRINCE HINSON
VICE PRESIDENT
112009 NW 31ST LANE
GAINESVILLE FL 32606-9322

Officer/Director/Trustee Three

SANDRA HAMILTON HILL
TREASURER
14070 BIG CREST LANE
WOODBRIDGE VA 22191-7549

Officer/Director/Trustee Four

SYLVIA MCQUEEN
SECRETARY
608 MOUNT HOOD DRIVE
ANTIOCH TN 37013-6170

Organization’s website WWW.PTPFTHS.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/23/2014
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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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