FORM 1023-EZ for PROSTATE CANCER RESEARCH FOUNDATIONOF ALABAMA

Field Data
EIN 81-2296439
Case Number EO-2016173-000211
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PROSTATE CANCER RESEARCH FOUNDATIONOF ALABAMA
Organization’s Mailing Address 420 20TH STREET NORTH SUITE 1400
City BIRMINGHAM
State AL
ZIP 35203-5200
Accounting period End 12
Primary contact name ALLEN BLOW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ED MEYERSON
PRESIDENT AND DIRECTOR
420 20TH STREET NORTH
BIRMINGHAM AL 35203-5200

Officer/Director/Trustee Two

FRANK BROCATO
TREASURER AND DIRECTOR
1589 JAMES HILL COVE
BIRMINGHAM AL 36226-4718

Officer/Director/Trustee Three

MICHAEL SLIVE
VICE-PRESIDENT AND DIRECTOR
1613 PANORAMA DRIVE
BIRMINGHAM AL 35216-3703

Officer/Director/Trustee Four

JOEL ROTENSTREICH
SECRETARY AND DIRECTOR
3311 DUNBROOKE DRIVE
BIRMINGHAM AL 35243-4818

Officer/Director/Trustee Five

TONY PETELOS
DIRECTOR
5178 SAPPHIRE RIDGE
HOOVER AL 35244-4173

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/15/2016
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code U11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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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