FORM 1023-EZ for THE TJ BERN FAMILY FOUNDATION

Field Data
EIN 87-2066078
Case Number EO-2021237-000315
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE TJ BERN FAMILY FOUNDATION
Organization’s Mailing Address 780 SAWDUST RD APT 360
City SPRING
State TX
ZIP 77380
Accounting period End 12
Primary contact name NICHOLAS A DUPRE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TUCKER BERN
DIRECTOR
780 SAWDUST RD APT 360
SPRING TX 77380

Officer/Director/Trustee Two

RONDA BERN
DIRECTOR
4311 OAKWOOD LN
WEST DES MOINES IA 50265

Officer/Director/Trustee Three

RANDY BERN
DIRECTOR
4311 OAKWOOD LN
WEST DES MOINES IA 50265

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/2/2021
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: No
Religious: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TUCKER BERN
Signature Title DIRECTOR
Signature Date 8/23/2021

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