FORM 1023-EZ for AMIGOS DE HOGAR CLINICA SAN JUAN DEDIOS INC

Field Data
EIN 45-2827604
Case Number EO-2015029-000238
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AMIGOS DE HOGAR CLINICA SAN JUAN DEDIOS INC
Organization’s Mailing Address 1492 SOUTH MIAMI AVENUE
City MIAMI
State FL
ZIP 33130-4322
Accounting period End 12
Primary contact name ALICIA CERVERA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ALICIA CERVERA
PRESIDENT
1236 ANASTASIA AVENUE
CORAL GABLES FL 33134

Officer/Director/Trustee Two

LUCRECIA LOUMIET
VICE PRESIDENT TREASURER
1033 ANASTASIA AVENUE
CORAL GABLES FL 33134

Officer/Director/Trustee Three

LEONOR FLORIAN
VICE PRESIDENT SECRETARY
13670 SW 78TH STREET
MIAMI FL 33183

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/23/2011
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W11 - Single Organization Support
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 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 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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