| Field | Data |
|---|---|
| EIN | 83-0571865 |
| Case Number | EO-2018150-000042 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | FLORIDA BEHAVIORAL HEALTH CENTRE INC |
| Organization’s Mailing Address | 1308 INDIANA AVENUE |
| City | LYNN HAVEN |
| State | FL |
| ZIP | 32444-2628 |
| Accounting period End | 12 |
| Primary contact name | TONI SHAMPLAIN PRESIDENT |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
TONI SHAMPLAIN
PRESIDENT
1308 INDIANA AVENUE
LYNN HAVEN FL 32444-2628
THOMAS GOSHA
SECRETARY
1308 INDIANA AVENUE
LYNN HAVEN FL 32444-2628
EUGENE JACKSON
TREASURER
125 SANTEE DRIVE
PANAMA CITY FL 32404-6050
| Organization’s website | |
|---|---|
| Organization’s email | TSHAMPL02@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/19/18 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P20 - Human Service Organizations - Multipurpose |
| 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 | Yes |
| 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 | Yes |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | TONI SHAMPLAIN |
| Signature Title | PRESIDENT |
| Signature Date | 5/24/18 |
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