FORM 1023-EZ for COVERED SOUTH FLORIDA INC

Field Data
EIN 86-3493388
Case Number EO-2021203-000149
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COVERED SOUTH FLORIDA INC
Organization’s Mailing Address 261 NW 13TH ST
City BOCA RATON
State FL
ZIP 33432
Accounting period End 12
Primary contact name SHAWN P EBERT CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DOUG PATON
CHAIR
261 NW 13TH ST
BOCA RATON FL 33432

Officer/Director/Trustee Two

MARGI CROSS
VICE CHAIR
261 NW 13TH ST
BOCA RATON FL 33432

Officer/Director/Trustee Three

KATIE GIANI
SECRETARY
261 NW 13TH ST
BOCA RATON FL 33432

Officer/Director/Trustee Four

NANCY WALSH
TREASURER
261 NW 13TH ST
BOCA RATON FL 33432

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/15/2021
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: 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DOUG PATON
Signature Title CHAIR
Signature Date 7/20/2021

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