| Field | Data |
|---|---|
| EIN | 47-4137933 |
| Case Number | EO-2018241-000163 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | PSI HEALTH CARE SERVICES INC |
| Organization’s Mailing Address | 3890 DUNN AVE SUITE 1104 |
| City | JACKSONVILLE |
| State | FL |
| ZIP | 32218-6234 |
| Accounting period End | 12 |
| Primary contact name | RICKY B WALLACE |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
RICKY WALLACE
PRESIDENT
3890 DUNN AVE SUITE 1104
JACKSONVILLE FL 32218-6234
LATOYA FRAZIER
SEC
3890 DUNN AVE SUITE 1104
JACKSONVILLE FL 32218-6234
HORACE LUMPKIN
TREAS
3890 DUNN AVE SUITE 1104
JACKSONVILLE FL 32218-6234
| Organization’s website | PSI Behavioral Health, LLC |
|---|---|
| Organization’s email | rwallace@psibh.com |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 6/1/15 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | F32 - Community Mental Health Center |
| Organization’s purpose | Charitable: Yes Religious: No Educational: No 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 | Yes |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | RICKY WALLACE |
| Signature Title | PRESIDENT |
| Signature Date | 8/27/18 |
| EIN | 47-4137933 |
| Case Number | EO-2015154-000251 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | PSI HEALTH CARE SERVICES INC |
| Organization’s Mailing Address | 3890 DUNN AVE SUITE 1104 |
| City | JACKSONVILLE |
| State | FL |
| ZIP | 32218 |
| Accounting period End | 12 |
| Primary contact name | RICKY WALLACE |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $400.00 |
RICKY WALLACE
PRESIDENT
3890 DUNN AVE SUITE 1104
JACKSONVILLE FL 32218
LATOYA FRAZIER
SEC
3890 DUNN AVE SUITE 1104
JACKSONVILLE FL 32218
HORACE LUMPKIN
TREA
3890 DUNN AVE SUITE 1104
JACKSONVILLE FL 32218
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 6/1/2015 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E21 - Community Health Systems |
| 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 | Yes |
| 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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