FORM 1023-EZ for MOREHOUSE HEALTHCARE FOUNDATION

Field Data
EIN 82-2299038
Case Number EO-2017236-000296
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOREHOUSE HEALTHCARE FOUNDATION
Organization’s Mailing Address 323 WEST WALNUT AVENUE
City BASTROP
State LA
ZIP 71220
Accounting period End 12
Primary contact name ADRIENNE WILLIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DERRICK FRAZIER
OFFICER
2102 OLD STERLINGTON ROAD
STERLINGTON LA 71280

Officer/Director/Trustee Two

BOB GREEN
OFFICER
7680 GREEN CREST CIRCILE
BASTROP LA 71220

Officer/Director/Trustee Three

ADRIENNE WILLIS
DIRECTOR
323 WEST WALNUT AVENUE
BASTROP LA 71220

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/31/2017
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
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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