FORM 1023-EZ for PHYSICIAN ASSISTANTS IN CARDIO THORACIC SURGERY INC

Field Data
EIN 46-1145552
Case Number EO-2014230-000032
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PHYSICIAN ASSISTANTS IN CARDIO THORACIC SURGERY INC
Organization’s Mailing Address 500 CUMMINGS CENTER SUITE 4550
City BEVERLY
State MA
ZIP 01915
Accounting period End 8
Primary contact name KERRI NATALE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JONATHAN SOBEL
PRESIDENT
100 E 77TH STREET
NEW YORK NY 10075

Officer/Director/Trustee Two

DAVID BUNNELL
SECRETARY-TREASURER
4610 LEARNED SAGE
ELLICOT CITY MD 21042-5932

Officer/Director/Trustee Three

DAVID LIZZOTTE
VICE PRESIDENT
2301 S 3RD STREET
LOUISVILLE KY 40292

Officer/Director/Trustee Four

DOUG LONG
DIRECTOR
65 FIELDSTONE WAY
MOUNTAIN TOP PA 18707

Officer/Director/Trustee Five

STEVE GOTTESFELD
DIRECTOR
2929 HEALTH CENTER DRIVE
SAN DIEGO CA 92123

Organization’s website WWW.APACVS.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/17/2012
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T99 - Philanthropy, Voluntarism, and Grantmaking Foundations N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 Yes
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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