FORM 1023-EZ for FIRST RESPONSE ACUPUNCTURE CORP

Field Data
EIN 83-2133724
Case Number EO-2018288-000437
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FIRST RESPONSE ACUPUNCTURE CORP
Organization’s Mailing Address 729 WING FOOT LN
City MELBOURNE
State FL
ZIP 32940
Accounting period End 12
Primary contact name NICOLE KELLY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NICOLE KELLY
DIRECTOR
729 WING FOOT LN
MELBOURNE FL 32940

Officer/Director/Trustee Two

STEVEN KELLY
DIRECTOR
729 WING FOOT LN
MELBOURNE FL 32940

Officer/Director/Trustee Three

ROGER SEVIGNY
DIRECTOR
948 WILDWOOD DR
MELBOURNE FL 32940

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/2/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: Yes
Literary: Yes
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 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 Yes
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 NICOLE KELLY
Signature Title DIRECTOR
Signature Date 10/11/18

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