| Field | Data |
|---|---|
| EIN | 84-3984415 |
| Case Number | EO-2020027-000228 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | PHYSWELL FOUNDATION |
| Organization’s Mailing Address | 14797 PHILIPS HWY SUITE 114 |
| City | JACKSONVILLE |
| State | FL |
| ZIP | 32256 |
| Accounting period End | 12 |
| Primary contact name | DAVID SHUTE |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
DAVID SHUTE
PRESIDENT
61 CARLSON CT
PONTE VEDRA FL 32081
DEANNA WOOD
VICE PRESIDENT
7800 POINT MEADOWS DR APT 524
JACKSONVILLE FL 32256
TYLER JACKSON
DIRECTOR
14951 WALDEN SPRINGS WAY APT 129
JACKSONVILLE FL 32258
LAUREN SHUTE
TREASURER
61 CARLSON CT
PONTE VEDRA FL 32081
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/1/2020 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E60 - Health Support Services |
| 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 | Yes |
| 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 | DAVID SHUTE |
| Signature Title | PRESIDENT |
| Signature Date | 1/23/2020 |
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