FORM 1023-EZ for PEDIATRIC ANGELS INC

Field Data
EIN 82-0628446
Case Number EO-2017080-000146
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PEDIATRIC ANGELS INC
Organization’s Mailing Address 9898 BISSONNET STREET STE 589
City HOUSTON
State TX
ZIP 77036
Accounting period End 12
Primary contact name DORIS FOMBIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DORIS FOMBIN
EXECUTIVE DIRECTOR - TRUSTEE
12807 STRATFORD HEIGHTS DR
SUGAR LAND TX 77498

Officer/Director/Trustee Two

BELLAMY KRAVITZ
SECRETARY - TRUSTEE
9220 NATHANIEL STREET APT 678
HOUSTON TX 77075

Officer/Director/Trustee Three

MIRIANNE ANDEHAKWI
TREASURER - TRUSTEE
111 BAPTIST STREET STE 103
SALISBURY MD 21801

Organization’s website WWW.PEDIATRICANGELS.ORG
Organization’s email INFO@PEDIATRICANGELS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/16/2017
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E92 - Home Health Care
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 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
Signature Title
Signature Date

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