FORM 1023-EZ for AMERICAN MEDICAL DEBT RELIEF FOUNDATION

Field Data
EIN 81-5050990
Case Number EO-2017065-000243
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AMERICAN MEDICAL DEBT RELIEF FOUNDATION
Organization’s Mailing Address 6612 MERCER STREET
City HOUSTON
State TX
ZIP 77005
Accounting period End 12
Primary contact name PIERCE HOLLIER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LARRY HOLLIER
PRESIDENT/DIRECTOR
6612 MERCER STREET
HOUSTON TX 77005

Officer/Director/Trustee Two

PIERCE HOLLIER
VICE PRESIDENT/DIRECTOR
6612 MERCER STREET
HOUSTON TX 77005

Officer/Director/Trustee Three

LAUR MONSON
DIRECTOR
6612 MERCER STREET
HOUSTON TX 77005

Officer/Director/Trustee Four

MALLORY CALDWELL
SECRETARY/DIRECTOR
6612 MERCER STREET
HOUSTON TX 77005

Officer/Director/Trustee Five

JIM THORNTON
TREASURER/DIRECTOR
6612 MERCER STREET
HOUSTON TX 77005

Organization’s website
Organization’s email PCHOLLIER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/16/2017
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T12 - Fund Raising and/or Fund Distribution
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 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
Signature Title
Signature Date

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