FORM 1023-EZ for LISA HALVERSON FOUNDATION

Field Data
EIN 83-3180759
Case Number EO-2019045-000072
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LISA HALVERSON FOUNDATION
Organization’s Mailing Address 16644 NW PAISLEY DRIVE
City BEAVERTON
State OR
ZIP 97006
Accounting period End 12
Primary contact name BENJAMIN WELLS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RUSSELL HALVERSON
PRESIDENT
315 PAUWELLA ROAD
HAIKU HI 96708

Officer/Director/Trustee Two

BENJAMIN WELLS
SECRETARY
16644 NW PAISLEY DRIVE
BEAVERTON OR 97006

Officer/Director/Trustee Three

ERICA WELLS
MEMBER AT LARGE
16644 NW PAISLEY DRIVE
BEAVERTON OR 97006

Organization’s website LISASKIDS.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/10/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name BENJAMIN WELLS
Signature Title SECRETARY
Signature Date 2/12/19

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