FORM 1023-EZ for OPTIMAL MIND INSTITUTE
| Field | Data |
|---|---|
| EIN | 82-1554762 |
| Case Number | EO-2017150-000426 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | OPTIMAL MIND INSTITUTE |
| Organization’s Mailing Address | 630 S RAYMOND AVE UNIT 310 |
| City | PASADENA |
| State | CA |
| ZIP | 91105-3206 |
| Accounting period End | 12 |
| Primary contact name | STEPHANIE MEJIA |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
ROXANNE PRILUTSKY PHD
CHIEF EXECUTIVE OFFICER
630 S RAYMOND AVE UNIT 310
PASADENA CA 91105-3206
Officer/Director/Trustee Two
WILLIAM DOVE
CHIEF FINANCIAL OFFICER
9415 CULVER BLVD UNIT 200
CULVER CITY CA 90232-2616
Officer/Director/Trustee Three
STEPHANIE MEJIA
SECRETARY
1120 N FLORES ST APT 10
WEST HOLLYWOOD CA 90069-2924
Officer/Director/Trustee Four
MIKHAIL GAFT
OFFICER
215 N WHITNALL HWY
BURBANK CA 91505-3520
Officer/Director/Trustee Five
ROZA ZOGRABYAN PSYD
DIRECTOR
100 N BRAND BLVD UNIT 209
GLENDALE CA 91203-2641
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 5/1/2017 |
| Organization Incorporation State | CA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | F30 - Mental Health Treatment - Multipurpose and N.E.C. |
| 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 | 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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