FORM 1023-EZ for PUBLIC SAFETY WELLNESS FOUNDATION INC

Field Data
EIN 84-2829924
Case Number EO-2019304-000245
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PUBLIC SAFETY WELLNESS FOUNDATION INC
Organization’s Mailing Address 5201 FIELDVIEW COURT
City ORLANDO
State FL
ZIP 32819
Accounting period End 12
Primary contact name STANLEY HAIMES MD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STANLEY HAIMES MD
PRESIDENT
5201 FIELDVIEW COURT
ORLANDO FL 32819

Officer/Director/Trustee Two

MICHAEL CLELLAND ESQ
DIRECTOR
1440 MAGNOLIA AVE
WINTER PARK FL 32789

Officer/Director/Trustee Three

TODD HUSTY DO
DIRECTOR
3040 S TUSCAWILLA ROAD
OVIEDO FL 32765

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/21/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H40 - Specific Organ Research
Organization’s purpose Charitable: No
Religious: No
Educational: No
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 STANLEY HAIMES MD
Signature Title PRESIDENT
Signature Date 10/29/19

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