FORM 1023-EZ for THE BLACK HEALTH MATTERS FOUNDATION

Field Data
EIN 47-5446921
Case Number EO-2018204-000208
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE BLACK HEALTH MATTERS FOUNDATION
Organization’s Mailing Address 412 HEIGHTS DRIVE
City HALEDON
State NJ
ZIP 7508
Accounting period End 12
Primary contact name ROSLYN DANIELS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES FIDDMONT
VICE PRESIDENT
412 HEIGHTS DRIVE
HALEDON NJ 7508

Officer/Director/Trustee Two

SELMA YOUNG
CHAIRMAN
8814 WAINWRIGHT RD
WYNDMOOR PA 19038

Officer/Director/Trustee Three

ROSLYN DANIELS
PRESIDENT
412 HEIGHTS DRIVE
HALEDON NJ 7508

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/13/15
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ROSLYN DANIELS
Signature Title PRESIDENT
Signature Date 7/19/18

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