FORM 1023-EZ for SHALOM EYECARE MINISTRIES INC

Field Data
EIN 82-5354417
Case Number EO-2018150-000608
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SHALOM EYECARE MINISTRIES INC
Organization’s Mailing Address 5060 WHISTLING WIND AVE
City KISSIMMEE
State FL
ZIP 34758
Accounting period End 12
Primary contact name DAVID RIVERA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID RIVERA
PRESIDENT
5060 WHISTLING WIND AVE
KISSIMMEE FL 34758

Officer/Director/Trustee Two

DOUGLAS GOODEN
VICE-PRESIDENT
850 PERTH PLACE
KISSIMMEE FL 34758

Officer/Director/Trustee Three

MICHELLE POLIHRONAKIS
SECRETARY
4771 CAPITAL BLVD
SAINT CLOUD FL 34769

Organization’s website
Organization’s email DAVE_RIVERA51@HOTMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/27/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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 Yes
Conducting Activities Outside of United States Yes
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 DAVID RIVERA
Signature Title PRESIDENT
Signature Date 5/28/18

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