FORM 1023-EZ for ANDREA R LACY SCHOLARSHIP FUND

Field Data
EIN 85-3353101
Case Number EO-2021064-001336
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ANDREA R LACY SCHOLARSHIP FUND
Organization’s Mailing Address 1442 S WINCHESTER BLVD NUM 249
City SAN JOSE
State CA
ZIP 95128
Accounting period End 12
Primary contact name STEVEN ISLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREA LACY
CEO
1442 S WINCHESTER BLVD NUM 249
SAN JOSE CA 95128

Officer/Director/Trustee Two

ANDREA LACY
SECRETARY
1442 S WINCHESTER BLVD NUM 249
SAN JOSE CA 95128

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/14/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 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 ANDREA LACY
Signature Title SECRETARY
Signature Date 1/11/2021

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