FORM 1023-EZ for TREE OF LIFE SOCIAL ADULT DAY CARE

Field Data
EIN 85-4032908
Case Number EO-2021028-000209
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TREE OF LIFE SOCIAL ADULT DAY CARE
Organization’s Mailing Address 112 COMMERCIAL STREET
City FREEPORT
State NY
ZIP 11520
Accounting period End 12
Primary contact name KONSTATINE KHAIMOV
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KONSTANTINE KHAIMOV
PRESIDENT
112 COMMERCIAL STREET
FREEPORT NY 11224

Officer/Director/Trustee Two

VIKTORIYA DZHAVAKHISHVILI
TREASURER
4336 MANHATTAN AVENUE
BROOKLYN NY 11224

Officer/Director/Trustee Three

YOKOV LYBOVICH
CHAIRPERSON
112 COMMERCIAL STREET
FREEPORT NY 11520

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/16/2020
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P75 - Senior Continuing Care Communities
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 No
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 KONSTANTINE KHAIMOV
Signature Title PRESIDENT
Signature Date 12/7/2020

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