FORM 1023-EZ for JAIMIE COX FOUNDATION NFP

Field Data
EIN 83-4617164
Case Number EO-2019126-000506
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JAIMIE COX FOUNDATION NFP
Organization’s Mailing Address 4407 BELLVIEW WAY
City ROCKTON
State IL
ZIP 61072
Accounting period End 12
Primary contact name ADAM COX
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CAITLIN COX
PRESIDENT, DIRECTOR
14574 LORIS PL
SOUTH BELOIT IL 61080

Officer/Director/Trustee Two

NICK BLOCH
SECRETARY, DIRECTOR
60 E HARBOR DR
LAKE ZURICH IL 60047

Officer/Director/Trustee Three

ADAM COX
TREASURER, DIRECTOR
4407 BELLVIEW WAY
ROCKTON IL 61072

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/30/19
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 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 ADAM COX
Signature Title TREASURER, DIRECTOR
Signature Date 5/3/19

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