FORM 1023-EZ for FELLSMERE ACTION COMMUNITY TEAM INC

Field Data
EIN 47-4714692
Case Number EO-2018257-000487
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FELLSMERE ACTION COMMUNITY TEAM INC
Organization’s Mailing Address 22 SOUTH ORANGE STREET
City FELLSMERE
State FL
ZIP 32948
Accounting period End 12
Primary contact name PASTOR ANNIE BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANNIE BROWN
PRESIDENT
1025 WEST GRANT
FELLSMERE FL 32948

Officer/Director/Trustee Two

THEODORE PANKIEWICZ
VICE-PRESIDENT
801 BAILEY DR
SEBASTIAN FL 32958

Officer/Director/Trustee Three

SANDRA ZAVALA
SECRETARY
8666 99TH AVENUE
VERO BEACH FL 32967

Officer/Director/Trustee Four

ISABEL MARRON
TREASURER
56 NORTH BROADWAY
FELLSMERE FL 32948

Officer/Director/Trustee Five

KEITH TOUCHBERRY
REGISTERED AGENT
22 SOUTH ORANGE STREET
FELLSMERE FL 32948

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/26/15
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: Yes
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ANNIE BROWN
Signature Title PRESIDENT
Signature Date 9/12/18
EIN 47-4714692
Case Number EO-2017109-000144
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FELLSMERE ACTION COMMUNITY TEAM INC
Organization’s Mailing Address 22 SOUTH ORANGE STREET
City FELLSMERE
State FL
ZIP 32948
Accounting period End 12
Primary contact name PASTOR ANNIE MAE BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEITH TOUCHBERRY
REGISTERED AGENT
22 SOUTH ORANGE STREET
FELLSMERE FL 32948

Officer/Director/Trustee Two

PASTOR ANNIE BROWN
PRESIDENT
1025 WEST GRANT STREET
FELLSMERE FL 32948

Officer/Director/Trustee Three

CIDANELIA BROZENICK
VICE-PRESIDENT
PO BOX 2822
VERO BEACH FL 32961

Officer/Director/Trustee Four

SANDRA ZAVALA
SECRETARY
8666 99TH AVENUE
VERO BEACH FL 32967

Officer/Director/Trustee Five

ISABEL MARRON
TREASURER
56 NORTH BROADWAY
FELLSMERE FL 32948

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/26/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: No
Public Safety: Yes
Amateur Sports: No
Cruelty Prevention: Yes
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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