FORM 1023-EZ for OUR SAM FOUNDATION INC

Field Data
EIN 83-1127365
Case Number EO-2018199-000189
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name OUR SAM FOUNDATION INC
Organization’s Mailing Address 3605 ALLVIEW CIRCLE
City CINCINNATI
State OH
ZIP 45238
Accounting period End 12
Primary contact name KATHLEEN RENFROW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATHLEEN RENFROW
PRESIDENT
3605 ALLVIEW CIRCLE
CINCINNATI OH 45238

Officer/Director/Trustee Two

BRYAN HOELZER
TREASURER
5135 WEST FORK ROAD
CINCINNATI OH 45247

Officer/Director/Trustee Three

ERIN BANKS
CHAIRPERSON
25 DIVISION STREET UNIT 9
JERSEY CITY NJ 7302

Officer/Director/Trustee Four

WILLARD RENFROW
SECRETARY
3605 ALLVIEW CIRCLE
CINCINNATI OH 45238

Officer/Director/Trustee Five

KAYLA HILDEBRANDT
OFFICER
9288 FIELDS DRIVE
MASON OH 45040

Organization’s website OURSAMFOUNDATION.ORG
Organization’s email KATIE@OURSAMFOUNDATION.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/6/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F12 - Fund Raising and/or Fund Distribution
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 Yes
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 KATHLEEN RENFROW
Signature Title PRESIDENT
Signature Date 7/16/18

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