FORM 1023-EZ for FOCOMAH INC

Field Data
EIN 83-1117718
Case Number EO-2018235-000474
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FOCOMAH INC
Organization’s Mailing Address 1852 NEW YORK AVE
City BROOKLYN
State NY
ZIP 11210
Accounting period End 12
Primary contact name JEANNETTE JEAN-PIERRE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEANNETTE JEAN-PIERRE
PRESIDENT
1852 NEW YORK AVE
BROOKLYN NY 11210

Officer/Director/Trustee Two

DAVID GELIN
DIRECTOR
134-20 87TH AVE APT 7F
RICHMOND HILL NY 11418

Officer/Director/Trustee Three

FRANTZY DUVERNE
DIRECTOR
43 WILSON ROAD
VALLEY STREAM NY 11581

Organization’s website
Organization’s email FREDIJEA@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/4/18
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E32 - Ambulatory Health Center, Community Clinic
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 Yes
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 JEANNETTE JEAN-PIERRE
Signature Title PRESIDENT
Signature Date 8/21/18

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