FORM 1023-EZ for FLORIDA PSYCHOLOGICAL ASSOCIATED HEALTHCARE

Field Data
EIN 47-5258009
Case Number EO-2015289-000172
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FLORIDA PSYCHOLOGICAL ASSOCIATED HEALTHCARE
Organization’s Mailing Address 86599 MEADOWWOOD DRIVE
City YULEE
State FL
ZIP 32097
Accounting period End 6
Primary contact name JOHN M DREW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOHN DREW
PRESIDENT
86599 MEADOWWOOD DRIVE
YULEE FL 32097

Officer/Director/Trustee Two

JOHN MARTIN
VICE PRESIDENT
2120 HIGHLAND STREET
FERNANDINA BEACH FL 32034

Officer/Director/Trustee Three

DANIEL STURGESS
TREASURER
2626 MCGREGOR BLVD
FERNANDINA BEACH FL 32034

Officer/Director/Trustee Four

TIMOTHY QUALLS
SECRETARY
225 SOUTH ADAMS STREET
TALLAHASSEE FL 32301

Officer/Director/Trustee Five

DAVID HARDEE
DIRECTOR
1612 DADE STREET
FERNANDINA BEACH FL 32034

Organization’s website
Organization’s email HEALTHCARE@FLORIDAPSY.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/6/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, 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
Signature Title
Signature Date

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