FORM 1023-EZ for MARYLAND ACADEMY OF MEDICAL PSYCHOLOGISTS

Field Data
EIN 46-5446752
Case Number EO-2016074-000425
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MARYLAND ACADEMY OF MEDICAL PSYCHOLOGISTS
Organization’s Mailing Address 604 CROCUS DR
City ROCKVILLE
State MD
ZIP 20850
Accounting period End 12
Primary contact name SAMUEL DUTTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARK MUSE
DIRECTOR
604 CROCUS DRIVE
ROCKVILLE MD 20850

Officer/Director/Trustee Two

PETER SMITH
DIRECTOR
910 SOUTHERLY ROAD UNIT 246
TOWSON MD 21204

Officer/Director/Trustee Three

SAMUEL DUTTON
DIRECTOR
404 COLLEEN GARDEN LANE
SEVERNA PARK MD 21146

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/11/2014
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F03 - Professional Societies, Associations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: Yes
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence Yes
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 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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