FORM 1023-EZ for JEFFERSON FAMILY HEALTH FUND

Field Data
EIN 81-0586259
Case Number EO-2015342-000310
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JEFFERSON FAMILY HEALTH FUND
Organization’s Mailing Address 924 JEFFERSON AVENUE
City ROCHESTER
State NY
ZIP 14611-3797
Accounting period End 12
Primary contact name LINDA BAYER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WILLIAM BAYER
CEO/PRESIDENT
1086 EDGEWOOD AVENUE
ROCHESTER NY 14618-5357

Officer/Director/Trustee Two

MARK BROWN
VICE PRESIDENT
241 WEYMOUTH DRIVE
ROCHESTER NY 14625

Officer/Director/Trustee Three

ROBERT BOXER
TREASURER
78 PAVILION PARK
ROCHESTER NY 14620

Officer/Director/Trustee Four

LINDA BAYER
SECRETARY
1086 EDGEWOOD AVENUE
ROCHESTER NY 14618-5357

Officer/Director/Trustee Five

CHRISTINE MCMULLEN
DIRECTOR
349 MELWOOD DRIVE
ROCHESTER NY 14626

Organization’s website
Organization’s email NANABAYER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/28/2003
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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