FORM 1023-EZ for BLACK THERAPISTS PALM BEACH COUNTYINC

Field Data
EIN 85-0625142
Case Number EO-2020105-000047
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK THERAPISTS PALM BEACH COUNTYINC
Organization’s Mailing Address 1825 NW CORPORATE BLVD 110
City BOCA RATON
State FL
ZIP 33431
Accounting period End 12
Primary contact name RICHARD BOLKO ATTRN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEISHA HENRY
PRESIDENT
3900 WOODLAKE BLVD 201B
GREENACRES FL 33463

Officer/Director/Trustee Two

TERRENCE DOWDEL
TRES
3900 WOODLAKE BLVD 201B
GREENACRES FL 33463

Officer/Director/Trustee Three

RYSZARD BOLKO
SEC
3900 WOODLAKE BLVD 201B
GREENACRES FL 33463

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/20/2020
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 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 KEISHA HENRY
Signature Title PRESIDENT
Signature Date 4/12/2020

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