FORM 1023-EZ for HEAD AND NECK CANCER FOUNDATION

Field Data
EIN 84-3930468
Case Number EO-2021125-000234
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEAD AND NECK CANCER FOUNDATION
Organization’s Mailing Address 740 PORTLAND AVENUE UNIT 1513
City MINNEAPOLIS
State MN
ZIP 55415-3611
Accounting period End 12
Primary contact name ALLISON PLUNKETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEEPAK KADEMANI
DIR CHR PRES TREAS SECRY
740 PORTLAND AVENUE UNIT 1513
MINNEAPOLIS MN 55415-3611

Officer/Director/Trustee Two

JULIE KLINE
DIRECTOR
6331 HILTON COURT NORTH
PINE SPRINGS MN 55115-6875

Officer/Director/Trustee Three

MOLLY WELCH
DIRECTOR
1710 SHANNON DRIVE
ST. CLOUD MN 56301-1714

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/5/2019
Organization Incorporation State MN
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: Yes
Scientific: Yes
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 DEEPAK KADEMANI
Signature Title DIR CHR PRES TREAS SECRY
Signature Date 5/3/2021

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