FORM 1023-EZ for PINK HEALS UPPER ALABAMA CHAPTER

Field Data
EIN 81-5279618
Case Number EO-2018270-000464
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PINK HEALS UPPER ALABAMA CHAPTER
Organization’s Mailing Address 322 WALNUT ST
City SOUTHSIDE
State AL
ZIP 35907
Accounting period End 12
Primary contact name JUS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUSTIN ZEMO
TREASURER
3177 RADCLIFF RD
SOUTHSIDE AL 35907

Officer/Director/Trustee Two

LECIL HARRELSON
PRESIDENT
2453 SAND VALLEY RD
ATTALLA AL 35954

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/18/17
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T31 - Community Foundations
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 Yes
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JUSTIN ZEMO
Signature Title TREASURER
Signature Date 9/25/18

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