FORM 1023-EZ for PORT ST JOHN COMMUNITY FOUNDATION INC

Field Data
EIN 83-3971440
Case Number EO-2019262-000090
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PORT ST JOHN COMMUNITY FOUNDATION INC
Organization’s Mailing Address P O BOX 472
City SHARPES
State FL
ZIP 32959-472
Accounting period End 12
Primary contact name TRACEY C HIGGINBOTHAM EA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREW PROCELL
PRESIDENT
7375 BARTOW AVENUE
COCOA FL 32927

Officer/Director/Trustee Two

TIA MAHAN
VICE PRESIDENT
5148 ARLINGTON ROAD
COCOA FL 32926

Officer/Director/Trustee Three

RANDEL RODRIGUEZ
TREASURER/SECRETARY
4742 BROOKHAVEN STREET
COCOA FL 32927

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/27/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T31 - Community Foundations
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 ANDREW PROCELL
Signature Title PRESIDENT
Signature Date 9/17/19

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