FORM 1023-EZ for SHIFA CARE CLINIC INC

Field Data
EIN 81-1115662
Case Number EO-2016208-000465
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SHIFA CARE CLINIC INC
Organization’s Mailing Address 1821 SLAYTON STREET
City AUGUSTA
State GA
ZIP 30904
Accounting period End 12
Primary contact name SHAMIM MOHAMMAD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHAMIM MOHAMMAD
CEO
3971 HAMMOND FERRY
EVANS GA 30809

Officer/Director/Trustee Two

YOSEPH AL HASHMI
SECRETARY
P O BOX 279
AUGUSTA GA 30903

Officer/Director/Trustee Three

MOHAMED MAGED LOTFY
TREASURER
218 NICKLAUS COURT
EVANS GA 30809

Officer/Director/Trustee Five

FAHEEM NUSRAT
PRESIDENT
741 KEYES DRIVE
GROVETOWN GA 30813

Organization’s website
Organization’s email SHIFACARECLINIC@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/16/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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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