FORM 1023-EZ for ADSH INC

Field Data
EIN 47-5341652
Case Number EO-2018260-000242
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ADSH INC
Organization’s Mailing Address 333 LAURINA ST APT 218
City JACKSONVILLE
State FL
ZIP 32216
Accounting period End 12
Primary contact name PATRICK JACQUES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PATRICK JACQUES
FOUNDER/PRESIDENT
333 LAURINA ST APT 218
JACKSONVILLE FL 32216

Officer/Director/Trustee Two

WILLIAMS DORCEANS
VICE-PRESIDENT
8764 HUNTINGTON WOODS CIR S
JACKSONVILLE FL 32256

Officer/Director/Trustee Three

WIDNEY JACQUES
GRANT DIRECTOR
333 LAURINA ST APT 224
JACKSONVILLE FL 32216

Officer/Director/Trustee Four

JENNY C CYPRIEN
SECRETARY
333 LAURINA ST APT 223
JACKSONVILLE FL 32216

Officer/Director/Trustee Five

YVES JR LAFLEUR
DIRECTOR
2260 UNIVERSITY BLVD N APT 99B
JACKSONVILLE FL 32216

Organization’s website WWW.ADSH.ORG
Organization’s email ADSHINC123@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/16/15
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 Yes
Donation of funds Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More Yes
Gaming Activity Yes
Disaster relief assistance Yes
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 Yes
Correctness Declaration Yes
Signature Name PATRICK JACQUES
Signature Title FOUNDER/PRESIDENT
Signature Date 9/13/18
EIN 47-5341652
Case Number EO-2016048-000207
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ADSH INC
Organization’s Mailing Address 2260 UNIVERSITY BLVD APT 63
City JACKSONVLLE
State FL
ZIP 32211
Accounting period End 12
Primary contact name PATRICK JACQUES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PATRICK JACQUES
PRESIDENT
2260 UNIVERSITY BLVD APT 63
JACKSONVILLE FL 32211

Officer/Director/Trustee Two

YVES JR LAFLEUR
VICE PRESIDENT
2260 UNIVERSITY BLVD APT 63
JACKSONVILLE FL 32211

Officer/Director/Trustee Three

WIDNEY JACQUES
DIRECTOR
2260 UNIVERSITY BLVD APT 63
JACKSONVILLE FL 32211

Officer/Director/Trustee Four

JENNY CYPRIEN
SECRETARY
2260 UNIVERSITY BLVD
JACKSONVILLE FL 32211

Officer/Director/Trustee Five

MARIE LAFLEUR
TREASURER
2260 UNIVERSITY BLVD APT 63
JACKSONVILLE FL 32211

Organization’s website WWW.ADSH.ORG
Organization’s email ADMIN@ADSH.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/16/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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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