FORM 1023-EZ for FLORIDA CENTER FOR INTEGRATIVE TELEPSYCHIATRY AND TELEPSYCHOTHERAPY IN

Field Data
EIN 47-2290291
Case Number EO-2015187-000480
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FLORIDA CENTER FOR INTEGRATIVE TELEPSYCHIATRY AND TELEPSYCHOTHERAPY IN
Organization’s Mailing Address 9080 58TH DR E SUITE 200
City LAKEWOOD RANCH
State FL
ZIP 34243
Accounting period End 12
Primary contact name SHARON MCREYNOLDS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ELI KOLP
P
9080 58TH DR E SUITE 200
LAKEWOOD RANCH FL 34243

Officer/Director/Trustee Two

HARRIS FRIEDMAN
VP
1255 TOM COKER RD
LABELLE FL 33935

Officer/Director/Trustee Three

MARK SYLVESTER
T
9080 58TH DR E SUITE 200
LAKEWOOD RANCH FL 34243

Officer/Director/Trustee Four

SHARON MCREYNOLDS
S
5404 MAIN ST
NEW PORT RICHEY FL 34652-2503

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/10/2014
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F30 - Mental Health Treatment - Multipurpose and N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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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