FORM 1023-EZ for MPN CANCER CONNECTION

Field Data
EIN 47-4839850
Case Number EO-2015251-000168
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MPN CANCER CONNECTION
Organization’s Mailing Address 15439 MILLVIEW TRACE LN
City CHARLOTTE
State NC
ZIP 28227-8441
Accounting period End 12
Primary contact name DAVID WALLACE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAVID WALLACE
CEO
15439 MILLVIEW TRACE LN
CHARLOTTE NC 28227-8441

Officer/Director/Trustee Two

ERNEST PORTER
VICE PRESIDENT
2850 PARKS LAFFERTY
CONCORD NC 28025

Officer/Director/Trustee Three

GARY VOGT
SECRETARY/TREASURER
418 RT 40
TROY NY 12182

Organization’s website
Organization’s email DWALLACE@CAROLINA.RR.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/27/2015
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G30 - Cancer
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 Yes
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
Signature Title
Signature Date

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