FORM 1023-EZ for CHILDHOOD CANCER SURVIVORS FUND INC

Field Data
EIN 84-4951906
Case Number EO-2020064-000511
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CHILDHOOD CANCER SURVIVORS FUND INC
Organization’s Mailing Address 20330 NE 34TH CT
City AVENTURA
State FL
ZIP 33180
Accounting period End 12
Primary contact name ANDRIY YAKUSHYN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KSENIYA PLATONAVA
PRESIDENT / CHAIRWOMAN
20330 NE 34TH CT
AVENTURA FL 33180

Officer/Director/Trustee Two

ERIKA JUREVICIUTE
VICE PRESIDENT
20330 NE 34TH CT
AVENTURA FL 33180

Officer/Director/Trustee Three

ALEX SHTEPA
TREASURER
20330 NE 34TH CT
AVENTURA FL 33180

Officer/Director/Trustee Four

JONAS JARMOSHKA
DIRECTOR
20330 NE 34TH CT
AVENTURA FL 33180

Officer/Director/Trustee Five

ANDRIY YAKUSHYN
DIRECTOR
20330 NE 34TH CT
AVENTURA FL 33180

Organization’s website HTTP://CCSFUND.ORG
Organization’s email AYAKUSHYN@CCSFUND.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/1/2020
Organization Incorporation State FL
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 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 No
Correctness Declaration Yes
Signature Name ANDRIY YAKUSHYN
Signature Title DIRECTOR
Signature Date 3/2/2020

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