FORM 1023-EZ for GALEN INSTITUTE INC

Field Data
EIN 46-5342348
Case Number EO-2015261-000146
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GALEN INSTITUTE INC
Organization’s Mailing Address 1056 GOODLETTE FRANK RD NORTH 100
City NAPLES
State FL
ZIP 34102
Accounting period End 12
Primary contact name ANDREA ROMERO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANDREA ROMERO
DIRECTOR
1056 GOODLETTE FRANK RD NORTH 100
NAPLES FL 34102

Officer/Director/Trustee Two

ISALI BEN JACOB
DIRECTOR
4505 W FLAGLER ST 202
MIAMI FL 33134

Officer/Director/Trustee Three

TANYA LYNN SYMONETTE
DIRECTOR
1642 SW 18TH AVENUE
MIAMI FL 33145

Organization’s website
Organization’s email THEGALENINSTITUTE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/5/2014
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: 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 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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