FORM 1023-EZ for PSYCHOLOGISTS SUPPORTING PSYCHOLOGISTS IN TRAINING

Field Data
EIN 85-1030273
Case Number EO-2020210-000280
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PSYCHOLOGISTS SUPPORTING PSYCHOLOGISTS IN TRAINING
Organization’s Mailing Address 2774 ELECTRIC ROAD SUITE A
City ROANOKE
State VA
ZIP 24018
Accounting period End 12
Primary contact name SARA SPRAGUE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREA MILLER
PRESIDENT
2774 ELECTRIC ROAD SUITE A
ROANOKE VA 24018

Officer/Director/Trustee Two

ROB MCNAMARA
VICE PRESIDENT
2017 SOUTH JEFFERSON ST 2ND FLOOR
ROANOKE VA 24014

Officer/Director/Trustee Three

J NILE WAGLEY
TREASURER
1108 E MARKET ST
CHARLOTTESVILLE VA 22902

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/13/2020
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ANDREA MILLER
Signature Title PRESIDENT
Signature Date 7/23/2020

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