FORM 1023-EZ for NORTHWESTERN LOUISIANA CANCER FOUNDATION

Field Data
EIN 83-1235413
Case Number EO-2018233-000154
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NORTHWESTERN LOUISIANA CANCER FOUNDATION
Organization’s Mailing Address 211 MEDICAL DRIVE
City NATCHITOCHES
State LA
ZIP 71457
Accounting period End 12
Primary contact name SARAH STEWART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRYAN PICOU
PRESIDENT
907 PARKWAY DR
NATCHITOCHES LA 71457

Officer/Director/Trustee Two

SARAH STEWART
SECRETARY
211 MEDICAL DR
NATCHITOCHES LA 71457

Officer/Director/Trustee Three

ROGER CUNNINGHAM
TREASURER/DIRECTOR
321 BIENVILLE ST
NATCHITOCHES LA 71457

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/27/18
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ROGER CUNNINGHAM
Signature Title TREASURER/DIRECTOR
Signature Date 8/17/18

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