FORM 1023-EZ for PISGAH FOUNDATION

Field Data
EIN 46-4509443
Case Number EO-2019241-000167
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PISGAH FOUNDATION
Organization’s Mailing Address 7161 PEMBROKE RD
City PEMBROKE PINES
State FL
ZIP 33023
Accounting period End 12
Primary contact name HANS AZEMARD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HANS AZEMARD
PRES
3340 NW 215TH ST
MIAMI GARDENS FL 33056

Officer/Director/Trustee Two

AMIR SEYMOUR
D
3340 NW 215TH ST
MIAMI FL 33056

Officer/Director/Trustee Three

AMARAL JEAN-BART
D
3340 NW 215 ST
MIAMI FL 33056

Officer/Director/Trustee Four

ANDEL BROWN
D
3340 NW 215 ST
MIAMI FL 33056

Officer/Director/Trustee Five

ADEBOLA AWOGBAMI
D
3340 NW 215 ST
MIAMI FL 33056

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/24/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T22 - Private Independent Foundations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name HANS AZEMARD
Signature Title PRES
Signature Date 8/26/19

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