FORM 1023-EZ for CICK CANCER FOUNDATION

Field Data
EIN 81-1965857
Case Number EO-2016102-000351
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CICK CANCER FOUNDATION
Organization’s Mailing Address 35 MANCHESTER RD STE 11A BOX 176
City DERRY
State NH
ZIP 03038
Accounting period End 12
Primary contact name RUSSEL DAGOSTINO-DUDKA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RUSSELL DAGOSTINO-DUDKA
FOUNDER/CEO
43 BERRY RD
DERRY NH 03038

Officer/Director/Trustee Two

LINDA DAGOSTINO-DUDKA
PRESIDENT
43 BERRY RD
DERRY NH 03038

Organization’s website CICKCANCER.ORG
Organization’s email CICKCANCERFOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/6/2016
Organization Incorporation State NH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G12 - 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 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 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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