FORM 1023-EZ for JACK PITTS HEALTH FOUNDATION

Field Data
EIN 82-3858299
Case Number EO-2018061-000011
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JACK PITTS HEALTH FOUNDATION
Organization’s Mailing Address PO BOX 250014
City WEST BLOOMFIELD
State MI
ZIP 48325
Accounting period End 12
Primary contact name JACK PITTS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JACK PITTS
PRESIDENT/DIRECTOR
PO BOX 250014
WEST BLOOMFIELD MI 48325

Officer/Director/Trustee Two

MELVIN FARMER
TREASURER/DIRECTOR
PO BOX 250014
WEST BLOOMFIELD MI 48325

Officer/Director/Trustee Three

JACFQUES MCNEELY
SECRETARY/DIRECTOR
PO BOX 250014
WEST BLOOMFIELD MI 48325

Organization’s website
Organization’s email JNPITTS@COMCAST.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/6/17
Organization Incorporation State MI
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 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 JACK PITTS
Signature Title PRESIDENT/DIRECTOR
Signature Date 2/28/18

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