FORM 1023-EZ for PATIENT FINANCIAL NAVIGATOR FOUNDATION INC

Field Data
EIN 81-5068139
Case Number EO-2017074-000141
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PATIENT FINANCIAL NAVIGATOR FOUNDATION INC
Organization’s Mailing Address 828 BLUE LAKES BLVD N
City TWIN FALLS
State ID
ZIP 83301
Accounting period End 12
Primary contact name DENNIS R BROWN CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAYLAUN L EGUSQUIZA
PRESIDENT TREASURER
PO BOX 2521
TWIN FALLS ID 83303

Officer/Director/Trustee Two

DARYL WERT
VICE PRESIDENT
PO BOX 2521
TWIN FALLS ID 83303

Officer/Director/Trustee Three

JAYME KETTERLING
SECRETARY
1025 SAWTOOTH BLVD
TWIN FALLS ID 83301

Officer/Director/Trustee Four

DENNIS R BROWN
ASST TREASURER
828 BLUE LAKES BLVD N
TWIN FALLS ID 83301

Organization’s website
Organization’s email DAYLEE1@MINDSPRING.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/1/2017
Organization Incorporation State ID
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
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 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
Signature Title
Signature Date

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