FORM 1023-EZ for LEE COUNTY MEDICAL SOCIETY FOUNDATION INC

Field Data
EIN 81-4328651
Case Number EO-2016312-000477
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LEE COUNTY MEDICAL SOCIETY FOUNDATION INC
Organization’s Mailing Address 13770 PLANTATION RD SUITE 1
City FORT MYERS
State FL
ZIP 33912
Accounting period End 12
Primary contact name JULIE RAMIREZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHARI SKINNER MD
PRESIDENT
8381 RIVERWALK PARK STE 101
FORT MYERS FL 33919

Officer/Director/Trustee Two

JON BURDZY DO
PRESIDENT -ELECT
7381 COLLEGE PKWY 110
FORT MYERS FL 33919

Officer/Director/Trustee Three

F RICK PALMON MD
TREASURER
6850 INTERNATIONAL CENTER BLVD
FORT MYERS FL 33912

Officer/Director/Trustee Four

DANIEL DE LA TORRE MD
SECRETARY
9981 S HEALTHPARK DR STE 159
FORT MYERS FL 33908

Officer/Director/Trustee Five

JULIE RAMIREZ
EXEC DIR
13770 PLANTATION ROAD SUITE 1
FORT MYERS FL 33912

Organization’s website WWW.LCMSFL.ORG
Organization’s email JRAMIREZ@LCMSFL.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/4/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E03 - Professional Societies, Associations
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
Signature Title
Signature Date

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