FORM 1023-EZ for PHIL PETERSEN MOMORIAL CENTER FOR DIABETES HEALTH INC

Field Data
EIN 47-3079576
Case Number EO-2015043-000379
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PHIL PETERSEN MOMORIAL CENTER FOR DIABETES HEALTH INC
Organization’s Mailing Address 2855 OCEAN DRIVE SUITE C2
City VERO BEACH
State FL
ZIP 32963-2039
Accounting period End 12
Primary contact name COLLEEN SANDERS SYMANSKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

COLLEEN SANDERS SYMANSKI RN CDE
PRESIDENT
2855 OCEAN DRIVE SUITE C2
VERO BEACH FL 32963-2039

Officer/Director/Trustee Two

LAURA PETERSEN
TREASURER
1603 US HWY 1
SEBASTIAN FL 32958-3834

Officer/Director/Trustee Three

CINDI GREEN RN
SECRETARY
2750 INDIAN RIVE BLVD
VERO BEACH FL 32960-5225

Officer/Director/Trustee Four

KENNETH SYMANSKI
DIRECTOR
2855 OCEAN DRIVE SUITE C2
VERO BEACH FL 32963-2039

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/26/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
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 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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