FORM 1023-EZ for JESUS MEDICAL CLINIC IN HAITI INC

Field Data
EIN 81-3482759
Case Number EO-2016228-000237
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JESUS MEDICAL CLINIC IN HAITI INC
Organization’s Mailing Address 1030 KINGS HWY N STE 200
City CHERRY HILL
State NJ
ZIP 08034-1907
Accounting period End 12
Primary contact name LAUREN KROHN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICHARD KIM
PRESIDENT
1030 KINGS HWY N STE 200
CHERRY HILL NJ 08034-1907

Officer/Director/Trustee Two

SUNG WHANG
VICE PRESIDENT
1030 KINGS HWY N STE 200
CHERRY HILL NJ 08034-1907

Officer/Director/Trustee Three

YOUNG LEE
TREASURER
1030 KINGS HWY N STE 200
CHERRY HILL NJ 08034-1907

Officer/Director/Trustee Four

NAM-JOO KIM
SECRETARY
1030 KINGS HWY N STE 200
CHERRY HILL NJ 08034-1907

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/3/2016
Organization Incorporation State NJ
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 No
Conducting Activities Outside of United States Yes
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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