| Field | Data |
|---|---|
| EIN | 84-4112522 |
| Case Number | EO-2021099-000311 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | WEST FLORIDA MEDICAL STAFF INC |
| Organization’s Mailing Address | 8383 NORTH DAVIS HWY |
| City | PENSACOLA |
| State | FL |
| ZIP | 32514 |
| Accounting period End | 12 |
| Primary contact name | CHARLOTTE HOOKS |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
JON MOORE
CHIEF OF STAFF
8383 NORTH DAVIS HWY
PENSACOLA FL 32514
JAMES FROST
CHAIR QUALITY & PEER REVIEW
8383 NORTH DAVIS HWY
PENSACOLA FL 32514
DAVID MILES
CHAIR CREDENTIALING COMMITTEE
8383 NORTH DAVIS HWY
PENSACOLA FL 32514
JEFFREY WOLTERS
CHAIR DEPT OF SURGERY
8383 NORTH DAVIS HWY
PENSACOLA FL 32514
TAMAR VASHAKMADZE
CHAIR DEPT OF MEDICINE
8383 NORTH DAVIS HWY
PENSACOLA FL 32514
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 10/29/2019 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | B03 - Professional Societies, Associations |
| Organization’s purpose | Charitable: No 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 | No |
| Benefit of College | No |
| Private Foundation 508(e) | Yes |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | JON MOORE |
| Signature Title | CHIEF OF STAFF |
| Signature Date | 3/19/2021 |
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