FORM 1023-EZ for PW3 PROSTATE FOUNDATION CORPORATION

Field Data
EIN 81-4327597
Case Number EO-2016365-000214
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PW3 PROSTATE FOUNDATION CORPORATION
Organization’s Mailing Address 7500 WHITE PLAINS LANE
City BRANDYWINE
State MD
ZIP 20613
Accounting period End 12
Primary contact name ERIC WADDY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERIC WADDY
DIRECTOR, CEO
7500 WHITE PLAINS LANE
BRANDYWINE DC 20613

Officer/Director/Trustee Two

KEISHEA JACKSON
DIRECTOR, COO
5525 CHILLUM PLACE NE
WASHINGTON DC 20011

Officer/Director/Trustee Three

HEATH JOHNSON
DIRECTOR, CFO
13001 AUTUMN DR
SILVER SPRING MD 20904

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/1/2016
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G12 - Fund Raising and/or Fund Distribution
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 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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