FORM 1023-EZ for JIMENEZ LEGACY FOUNDATION

Field Data
EIN 85-1247120
Case Number EO-2020155-000151
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JIMENEZ LEGACY FOUNDATION
Organization’s Mailing Address 355 N LANTANA SUITE 573
City CAMARILLO
State CA
ZIP 93010
Accounting period End 12
Primary contact name LACEY JIMENEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LACEY JIMENEZ
PRESIDENT
1125 MISSION VERDE DR
CAMARILLO CA 93012

Officer/Director/Trustee Two

TIMOTHY RYAN
DIRECTOR
436 POLI ST APT 407
VENTURA CA 93001

Officer/Director/Trustee Three

KARYN ADELSTEIN
VICE PRESIDENT
PO BOX 5181
PINE MTN CLUB CA 93222

Officer/Director/Trustee Four

ELIZABETH BAILEY
DIRECTOR
1155 LA GRANGE
NEWBURY PARK CA 91320

Officer/Director/Trustee Five

THERESA MONAGO
DIRECTOR
163 EAST CEDARWOOD CT
PALATINE IL 60067

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/30/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
Organization’s purpose Charitable: No
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 Yes
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 LACEY JIMENEZ
Signature Title PRESIDENT
Signature Date 6/1/2020

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