FORM 1023-EZ for FOUNDATION LAURENCIN FOR HEALTH

Field Data
EIN 46-3201376
Case Number EO-2014297-000515
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FOUNDATION LAURENCIN FOR HEALTH
Organization’s Mailing Address 268 MOUNTVERNON AVENUE
City ORANGE
State NJ
ZIP 07050
Accounting period End 6
Primary contact name CALVIN TAYLOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

FRITZ BAILEY
EXECUTIVE DIRECTOR
505 MAIN STREET
EAST ORANGE NJ 07018

Officer/Director/Trustee Two

LOUBEN LAURENT
DIRECTOR
268 MOUNT VERNON
ORANGE NJ 07050

Officer/Director/Trustee Three

LILIANE LAURENT
DIRECTOR
80 GLENSIDE AVE APT E37
MONTCLAIR NJ 07042

Officer/Director/Trustee Four

ANTOINE DESORMES
DIRECTOR
416 PARK AVE
EAST ORANGE NJ 07017

Officer/Director/Trustee Five

PIERRE CHARLES
DIRECTOR
13 LILLIAN AVE
HAMILTON NJ 08610

Organization’s website
Organization’s email CALVINCPA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/17/2013
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F21 - Alcohol, Drug Abuse, Prevention Only
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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
Signature Title
Signature Date

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