FORM 1023-EZ for MADELEINE MERCEDES BRAIN CANCER CORP

Field Data
EIN 83-1861132
Case Number EO-2019051-000473
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MADELEINE MERCEDES BRAIN CANCER CORP
Organization’s Mailing Address 1018 MARTIN TAVERN ROAD
City MORRISVILLE
State NC
ZIP 27560
Accounting period End 12
Primary contact name GISELL M LEVINE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GISELL M LEVINE
PRESIDENT
1018 MARTIN TAVERN ROAD
MORRISVILLE NC 27560

Officer/Director/Trustee Two

MARK LEVINE
VICE-PRESIDENT
1018 MARTIN TAVERN ROAD
MORRISVILLE NC 27560

Officer/Director/Trustee Three

DWAYNE RIVERA
TREASURER
61 ONEIDA AVENUE
OAKLAND NJ 7436

Officer/Director/Trustee Four

DR ANNE BARLOW BARRY
SECRETARY
49 RANGE ROAD UNIT 104
WINDHAM NH 3087

Officer/Director/Trustee Five

JAY FOERSTERLING
DIRECTOR
3723 CONFLANS ROAD
IRVING TX 75061

Organization’s website WWW.MMBCF.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/7/18
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 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 GISELL M LEVINE
Signature Title PRESIDENT
Signature Date 2/18/19

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