FORM 1023-EZ for CONNOR JAKE HUSEY MEMORIAL FOUNDATION INC

Field Data
EIN 84-4729860
Case Number EO-2020247-000058
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CONNOR JAKE HUSEY MEMORIAL FOUNDATION INC
Organization’s Mailing Address 1428 SW 28TH TER
City DEERFIELD BEACH
State FL
ZIP 33442
Accounting period End 12
Primary contact name JUDY HUSEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUDY HUSEY
DIRECTOR
1428 SW 28TH TER
DEERFIELD BEACH FL 33442

Officer/Director/Trustee Two

RODNEY HUSEY
DIRECTOR
1428 SW 28TH TER
DEERFIELD BEACH FL 33442

Officer/Director/Trustee Three

JOSEPH HUSEY
DIRECTOR
1428 SW 28TH TER
DEERFIELD BEACH FL 33442

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/5/2020
Organization Incorporation State FL
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 Yes
Donation of funds Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers Yes
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 JUDY HUSEY
Signature Title DIRECTOR
Signature Date 9/1/2020

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