FORM 1023-EZ for NATIONAL MINORITY TORCHBEARERS PROSTATE CANCER CONSORTIUM INC

Field Data
EIN 46-5016987
Case Number EO-2014265-000196
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NATIONAL MINORITY TORCHBEARERS PROSTATE CANCER CONSORTIUM INC
Organization’s Mailing Address 515 CHEVELLE LANE
City DECATUR
State GA
ZIP 30030-4471
Accounting period End 12
Primary contact name DR JAMES HALL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JAMES HALL
FOUNDER / CHAIRMAN
515 CHEVELLE LANE
DECATUR GA 30030-4471

Officer/Director/Trustee Two

IMAM FURQAN MUHAMMAD
VICE CHAIRMAN
1127 HANK AARON DR SW
ATLANTA GA 30315-1707

Officer/Director/Trustee Three

DONALD TAYLOR
PRESIDENT
P O BOX 1723
DECATUR GA 30031-4471

Officer/Director/Trustee Four

JADRIEN GRIMES
EXECUTIVE VICE PRESIDENT
P O BOX 1723
DECATUR GA 30031-4471

Officer/Director/Trustee Five

LARRY MCCUMBER
BOARD MEMBER SEC TREAS
P O BOX 1723
DECATUR GA 30031-4471

Organization’s website WWW.NATIONALMTPCC.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/29/2014
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 No
One Third Support Gifts Yes
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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