FORM 1023-EZ for MY HEALTHY CITY JAX INC

Field Data
EIN 87-1157748
Case Number EO-2021188-000125
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MY HEALTHY CITY JAX INC
Organization’s Mailing Address 10541 OSPREY NEST DRIVE EAST
City JACKSONVILLE
State FL
ZIP 32257
Accounting period End 12
Primary contact name BARRY M SCHUSTER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BARRY SCHUSTER
PRESIDENT
10541 OSPREY NEST DR E
JACKSONVILLE FL 32257-1036

Officer/Director/Trustee Two

RICHARD DOTSON
DIRECTOR
8663 SANCHEZ ROAD
JACKSONVILLE FL 32217

Officer/Director/Trustee Three

ELIOT SAFER
DIRECTOR
4348 SOUTHPOINT BLVD SUITE 101
JACKSONVILLE FL 32216

Officer/Director/Trustee Four

ROBERT BLACK
DIRECTOR
9273 WATERGLEN LANE
JACKSONVILLE FL 32256

Organization’s website
Organization’s email INFO@MYHEALTHYCITYJAX.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/10/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W01 - Alliance/Advocacy Organizations
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 BARRY SCHUSTER
Signature Title PRESIDENT
Signature Date 7/5/2021

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