FORM 1023-EZ for VITAL FOUNDATION INC

Field Data
EIN 82-1107344
Case Number EO-2017163-000222
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name VITAL FOUNDATION INC
Organization’s Mailing Address 1403 POWHATAN AVE
City TAMPA
State FL
ZIP 33604
Accounting period End 12
Primary contact name FLOR DE LIZ JUAREZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FLOR DE LIZ JUAREZ
PRESIDENT, DIRECTOR
1403 POWHATAN AVE
TAMPA FL 33604

Officer/Director/Trustee Two

MINERVA MARTINEZ
VICE PRESIDENT, DIRECTOR
2116 W SPRUCE ST
TAMPA FL 33607

Officer/Director/Trustee Three

CELEINY CLARK
SECRETARY, DIRECTOR
3359 HIDDEN HAVEN CT
TAMPA FL 33607

Officer/Director/Trustee Four

MONICA JOHLIC
TREASURER, DIRECTOR
6836 122ND WAY
SEMINOLE FL 33772

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/8/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 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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