FORM 1023-EZ for PEDIATRIC CANCER FUND INC

Field Data
EIN 82-3148348
Case Number EO-2017313-000081
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PEDIATRIC CANCER FUND INC
Organization’s Mailing Address 4781 FIREBROOK BLVD
City LEXINGTON
State KY
ZIP 40513
Accounting period End 12
Primary contact name JAMIE ENNIS BLOYD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMIE ENNIS BLOYD
DIRECTOR
4781 FIREBROOK BLVD
LEXINGTON KY 40513

Officer/Director/Trustee Two

ASHOK RAJ
DIRECTOR
571 S FLOYD ST
LOUSIVILLE KY 40202

Officer/Director/Trustee Three

LARS WAGNER
DIRECTOR
800 ROSE ST
LEXINGTON KY 40507

Officer/Director/Trustee Four

CORY MEADOWS
DIRECTOR
7719 NALAN DR
LOUISVILLE KY 40291

Officer/Director/Trustee Five

COURTNEY EMERY
DIRECTOR
3137 OAK HURST LN
LEXINGTON KY 40509

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/20/2017
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H98 - Pediatrics Research
Organization’s purpose Charitable: No
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
Signature Title
Signature Date

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