FORM 1023-EZ for JERE MELO FOUNDATION

Field Data
EIN 45-3987417
Case Number EO-2017261-000325
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JERE MELO FOUNDATION
Organization’s Mailing Address PO BOX 118
City FORT BRAGG
State CA
ZIP 95437
Accounting period End 12
Primary contact name JOHN ANDERSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MADELEINE MELO
PRESIDENT
120 JEWETT ST
FORT BRAGG CA 95437

Officer/Director/Trustee Two

JOHN ANDERSEN
CHAIR
327 PARK ST
FORT BRAGG CA 95437

Officer/Director/Trustee Three

ANNA RUSSELL
EXECUTIVE DIRECTOR
1222 WILLOW ST
FORT BRAGG CA 95437

Officer/Director/Trustee Four

LINDA ROYAT
BOARD MEMBER
19201 PINE TREE LN
FORT BRAGG CA 95437

Officer/Director/Trustee Five

LINWOOD PETERS
BOARD MEMBER
411 PARK ST
FORT BRAGG CA 95437

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/2/2011
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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