FORM 1023-EZ for INTERNATIONAL SOCIETY FOR FLUORESCENCE GUIDED SURGERY INC

Field Data
EIN 81-0709553
Case Number EO-2015343-000364
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name INTERNATIONAL SOCIETY FOR FLUORESCENCE GUIDED SURGERY INC
Organization’s Mailing Address 3255 NW 94TH AVE NUM 8711
City CORAL SPRINGS
State FL
ZIP 33065-9998
Accounting period End 12
Primary contact name JAY FLEISHER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MICHAEL BOUVET
BOARD MEMBER
3255 NW 94TH AVE NUM 8711
CORAL SPRINGS FL 33065-9998

Officer/Director/Trustee Two

TAKEAKI ISHIZAWA
BOARD MEMBER
3255 NW 94TH AVE NUM 8711
CORAL SPRINGS FL 33065-9998

Officer/Director/Trustee Three

FERNANDO DIP
BOARD MEMBER
3255 NW 94TH AVE NUM 8711
CORAL SPRINGS FL 33065-9998

Officer/Director/Trustee Four

RAUL ROSENTHAL
BOARD MEMBER
3255 NW 94TH AVE NUM 8711
CORAL SPRINGS FL 33065-9998

Officer/Director/Trustee Five

ELEKTRA MCDERMOTT
BOARD MEMBER
3255 NW 94TH AVE NUM 8711
CORAL SPRINGS FL 33065-9998

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/4/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
Organization’s purpose Charitable: Yes
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 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 Yes
One Third Support Gifts No
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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