FORM 1023-EZ for WELLNESS & BLADDER HEALTH CENTER FOUNDATION

Field Data
EIN 84-2666812
Case Number EO-2019339-000433
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WELLNESS & BLADDER HEALTH CENTER FOUNDATION
Organization’s Mailing Address 19015 TOWN CENTER STE 206
City APPLE VALLEY
State CA
ZIP 92308
Accounting period End 12
Primary contact name SANDRA STEWART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SANDRA STEWART
EXEC DIRECTOR-CEO
19015 TOWN CENTER STE 206
APPLE VALLEY CA 92308

Officer/Director/Trustee Two

ABRAHAM ESKENAZI
MD CHAIRMAN & BOARD PRES
19015 TOWN CENTER STE 206
APPLE VALLEY CA 92308

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/24/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SANDRA STEWART
Signature Title EXEC DIRECTOR-CEO
Signature Date 12/3/19

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