FORM 1023-EZ for DELK FAMILY FOUNDATION

Field Data
EIN 83-0644737
Case Number EO-2018199-000064
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DELK FAMILY FOUNDATION
Organization’s Mailing Address PO BOX 13071
City SALEM
State OR
ZIP 97309
Accounting period End 12
Primary contact name DAVID E ATKIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL DELK
PRESIDENT
PO BOX 13071
SALEM OR 97309

Officer/Director/Trustee Two

MOLLY LEBLANC
DIRECTOR
PO BOX 13071
SALEM OR 97309

Officer/Director/Trustee Three

MELINDA DECK
DIRECTOR
PO BOX 13071
SALEM OR 97309

Officer/Director/Trustee Four

CRYSTEL DYSON
SECRETARY
PO BOX 13071
SALEM OR 97309

Officer/Director/Trustee Five

MEGAN BARNES
DIRECTOR
PO BOX 13071
SALEM OR 97309

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T22 - Private Independent Foundations
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MICHAEL DELK
Signature Title PRESIDENT
Signature Date 7/16/18

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