FORM 1023-EZ for THREE ANGELS CLINIC INC

Field Data
EIN 45-4850675
Case Number EO-2014363-000118
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THREE ANGELS CLINIC INC
Organization’s Mailing Address PO BOX 772774
City OCALA
State FL
ZIP 34477
Accounting period End 12
Primary contact name KEVIN BARRETT - BOARD CHAIRMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KEVIN BARRETT
CHAIRMAN / TREASURER
5001 SW 20TH STREET-APT 811
OCALA FL 34474

Officer/Director/Trustee Two

JOANNE STERLING
MEDICAL DIRECTOR
PO BOX 772774
OCALA FL 34477

Officer/Director/Trustee Three

STELLA NEMUSESO
SECRETARY / DIRECTOR
9794 SW 125TH COURT ROAD
DUNNELLON FL 34432

Officer/Director/Trustee Four

HERMA COLE
DIRECTOR
4456 SW 102 LANE ROAD
OCALA FL 34476

Officer/Director/Trustee Five

WINSOME MARTIN
DIRECTOR
13077 SW 78TH TERRACE
OCALA FL 34473

Organization’s website WWW.THREEANGELSCLINICINC.COM
Organization’s email PATIENTCARE@THREEANGELSCLINICINC.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/16/2012
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
Religious: Yes
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 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 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
Signature Title
Signature Date

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