FORM 1023-EZ for FLORIDA TREATMENT FOR CHANGE DT INC

Field Data
EIN 83-3521116
Case Number EO-2019045-000099
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FLORIDA TREATMENT FOR CHANGE DT INC
Organization’s Mailing Address 2180 MARAVILLA LN
City FORT MYERS
State FL
ZIP 33901
Accounting period End 12
Primary contact name KARI-ANNE SPILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KARI-ANNE SPILLER
CEO
2917 NE 4TH PL
CAPE CORAL FL 33909

Officer/Director/Trustee Two

EILEEN KAPPERMAN
VICE PRESIDENT
263 SW 3RD TER
CAPE CORAL FL 33991

Officer/Director/Trustee Three

RICHARD MERCIER
TREASURER
155 LAS PALMAS BLV
NORTH FORT MYERS FL 33903

Officer/Director/Trustee Four

JAACQUELINE PINNOCK GARCIA
BOARD MEMBER
706 SE 9TH AVE
CAPE CORAL FL 33990

Officer/Director/Trustee Five

CAMELIA WAITE
BOARD MEMBER
4611 AQUALINDA BLVD
CAPE CORAL FL 33914

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/13/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F22 - Alcohol, Drug Abuse, Treatment Only
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 KARI-ANNE SPILLER
Signature Title CEO
Signature Date 2/12/19

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