| Field | Data |
|---|---|
| EIN | 82-1078642 |
| Case Number | EO-2017261-000186 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | MEDICAL STAFF OF PUTNAM COMMUNITY MEDICAL CENTER INC |
| Organization’s Mailing Address | 700 ZEAGLER DR STE 9 |
| City | PALATKA |
| State | FL |
| ZIP | 32177-3826 |
| Accounting period End | 12 |
| Primary contact name | DARREL WYATT |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
JOHN GAINES
PRESIDENT
530 ZEAGLER DR STE A
PALATKA FL 32177-6856
MOUSTAFA ELDICK
VICE PRESIDENT
899 SUMMIT ST
CRESCENT CITY FL 32112-2109
DARREL WYATT
SECRETARY TREASURER
700 ZEAGLER DR STE 9
PALATKA FL 32177-3826
LUCIEN TCHUISSE
DIRECTOR
6100 ST JOHNS AVE STE 6
PALATKA FL 32177-6859
CHRIS SALZMAN
DIRECTOR
414 ZEAGLER DR
PALATKA FL 32177-3815
| Organization’s website | N/A |
|---|---|
| Organization’s email | MEDICALSTAFF.PCMC@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/4/2017 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E03 - Professional Societies, Associations |
| 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 | |
| Signature Title | |
| Signature Date |
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