FORM 1023-EZ for INTERNATIONAL TREATMENT ACCESS FORSKIN CANCER INC

Field Data
EIN 84-3136017
Case Number EO-2019317-000165
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name INTERNATIONAL TREATMENT ACCESS FORSKIN CANCER INC
Organization’s Mailing Address 3025 GOVERNORS PLACE BLVD
City DAYTON
State OH
ZIP 45409
Accounting period End 12
Primary contact name HEIDI DONNELLY MD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HEIDI DONNELLY
PRESIDENT
3025 GOVERNORS PLACE BLVD
DAYTON OH 45409

Officer/Director/Trustee Two

JOSEPH MCGOWAN
VICE PRESIDENT
3025 GOVERNORS PLACE BLVD
DAYTON OH 45409

Officer/Director/Trustee Three

DENISE SILVA
SECRETARY
2009 N VICTORIA DR
SANTA ANA CA 92706

Officer/Director/Trustee Four

MARIO MARUTHUR
TREASURER
2304 WILLOW CREEK CT E
AUGUSTA GA 30909

Organization’s website ITASC.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/18/19
Organization Incorporation State OH
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: 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 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 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 HEIDI DONNELLY
Signature Title PRESIDENT
Signature Date 11/11/19
EIN 84-3136017
Case Number EO-2019317-000165
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name INTERNATIONAL TREATMENT ACCESS FOR SKIN CANCER INC
Organization’s Mailing Address 3025 GOVERNORS PLACE BLVD
City DAYTON
State OH
ZIP 45409
Accounting period End 12
Primary contact name HEIDI DONNELLY MD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HEIDI DONNELLY
PRESIDENT
3025 GOVERNORS PLACE BLVD
DAYTON OH 45409

Officer/Director/Trustee Two

JOSEPH MCGOWAN
VICE PRESIDENT
3025 GOVERNORS PLACE BLVD
DAYTON OH 45409

Officer/Director/Trustee Three

DENISE SILVA
SECRETARY
2009 N VICTORIA DR
SANTA ANA CA 92706

Officer/Director/Trustee Four

MARIO MARUTHUR
TREASURER
2304 WILLOW CREEK CT E
AUGUSTA GA 30909

Organization’s website ITASC.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/18/19
Organization Incorporation State OH
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: 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 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 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 HEIDI DONNELLY
Signature Title PRESIDENT
Signature Date 11/11/19

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