FORM 1023-EZ for THE MOMENTUM FOUNDATION INC

Field Data
EIN 83-3118810
Case Number EO-2019036-000780
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE MOMENTUM FOUNDATION INC
Organization’s Mailing Address 552 NW MERCANTILE PL
City PORT SAINT LUCIE
State FL
ZIP 34986
Accounting period End 12
Primary contact name WILLIAM HAVIK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM HAVIK
PRESIDENT
224 SW FERNLEAF TRL
PORT SAINT LUCIE FL 34953

Officer/Director/Trustee Two

MYLENE ST-JACQUES
VICE-PRESIDENT
224 SW FERNLEAF TRL
PORT SAINT LUCIE FL 34953

Officer/Director/Trustee Three

RACHEL TENNANT
TREASURER
7626 PINE LAKES BLVD
PORT SAINT LUCIE FL 34952

Organization’s website
Organization’s email BILLY@HAVIKCIRCUS.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/6/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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 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 WILLIAM HAVIK
Signature Title PRESIDENT
Signature Date 1/22/19

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