FORM 1023-EZ for INDIANA COUNCIL OF CHILD AND ADOLESCENT PSYCHIATRY INC

Field Data
EIN 83-4137617
Case Number EO-2019087-000415
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name INDIANA COUNCIL OF CHILD AND ADOLESCENT PSYCHIATRY INC
Organization’s Mailing Address 705 RILEY HOSP DR STE 4300
City INDIANAPOLIS
State IN
ZIP 46202
Accounting period End 12
Primary contact name M PLAWECKI OR JULIANNA M PLAWECKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARTIN PLAWECKI
DIRECTOR
705 RILEY HOSPITAL DR SUITE 4300
INDIANAPOLIS IN 46202

Officer/Director/Trustee Two

ANDREW MILLER
DIRECTOR
8092 HEYWARD DRIVE
INDIANAPOLIS IN 46250

Officer/Director/Trustee Three

MICHAEL LITWILLER
DIRECTOR
9670 E WASHINGTON ST NO 120
INDIANAPOLIS IN 46229

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/12/18
Organization Incorporation State IN
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 No
Compensation of Officer director trustee No
Donation of funds Yes
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 MARTIN PLAWECKI
Signature Title DIRECTOR
Signature Date 3/26/19

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