FORM 1023-EZ for PRIME WELLNESS CENTERS FOUNDATION

Field Data
EIN 47-1743974
Case Number EO-2014260-000294
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PRIME WELLNESS CENTERS FOUNDATION
Organization’s Mailing Address 10661 NE QUAYBRIDGE CT
City MIAMI
State FL
ZIP 33138
Accounting period End 12
Primary contact name WILLIAM ZUBKOFF
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WILLIAM ZUBKOFF
EXECUTIVE DIRECTOR
10661 NE QUAYBRIDGE COURT
MIAMI FL 33138

Officer/Director/Trustee Two

JOYCE GALBUT
DIRECTOR
10661 NE QUAYBRIDGE COURT
MIAMI FL 33138

Officer/Director/Trustee Three

JOSEPH TEMPELBERG
DIRECTOR
10661 NE QUAYBRIDGE COURT
MIAMI FL 33138

Organization’s website
Organization’s email WZUBKOFF@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/3/2014
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E21 - Community Health Systems
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 Yes
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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