FORM 1023-EZ for REJUVENATION AND WELLNESS INC

Field Data
EIN 82-1602329
Case Number EO-2017150-000375
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name REJUVENATION AND WELLNESS INC
Organization’s Mailing Address 17640 WOODVIEW TERRACE
City BOCA RATON
State FL
ZIP 33487
Accounting period End 12
Primary contact name MICHELE GOOTENBERG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHELE GOOTENBERG
PRESIDENT
17640 WOODVIEW TERRACE
BOCA RATON FL 33487

Officer/Director/Trustee Two

LLOYD GOOTENBERG
DIRECTOR
17640 WOODVIEW TERRACE
BOCA RATON FL 33487

Officer/Director/Trustee Three

KATIE GOOTENBERG
V.P.
226 N CLINTON STREET
CHICAGO IL 60661

Officer/Director/Trustee Four

RACHEL GOOTENBERG
V.P.
17640 WOODVIEW TERRACE
BOCA RATON FL 33487

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/15/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K40 - Nutrition Programs
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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