FORM 1023-EZ for MUSIC IN MEDICINE INC

Field Data
EIN 82-5289595
Case Number EO-2018128-001175
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MUSIC IN MEDICINE INC
Organization’s Mailing Address 2219 E MARCIA STREET
City INVERNESS
State FL
ZIP 34453
Accounting period End 12
Primary contact name ADELE JACOBSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ADELE JACOBSON
CHAIR AND PRESIDENT
2219 E MARCIA STREET
INVERVESS FL 34453

Officer/Director/Trustee Two

PHILLIS ROSETTI-MERCER
DIRECTOR
209 SE PARADISE PT RD
CRYSTAL RIVER FL 34429

Officer/Director/Trustee Three

JIM DAVIS
DIRECTOR
44 DOGWOOD DRIVE
HOMOSASSA FL 34446

Officer/Director/Trustee Four

GUSTAVO FONSECA
DIRECTOR
521 N LECANTO HWY
LECANTO FL 34461

Officer/Director/Trustee Five

PENNY ZAPHELS
DIRECTOR
502 W HIGHLAND BLVD
INVERNESS FL 34452

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/13/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G48 - Brain Disorders
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 ADELE JACOBSON
Signature Title CHAIR AND PRESIDENT
Signature Date 5/6/18

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