FORM 1023-EZ for K-DOG FOUNDATION

Field Data
EIN 10-0935137
Case Number EO-2019212-000253
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name K-DOG FOUNDATION
Organization’s Mailing Address 310 WOODRICH LN
City LAFAYETTE
State LA
ZIP 70507-5206
Accounting period End 12
Primary contact name AMANDA SIMMONS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AMANDA SIMMONS
CEO
310 WOODRICH LN
LAFAYETTE LA 70507-5206

Officer/Director/Trustee Two

ALTON JR ANTOINE
EXECUTIVE VICE- PRESIDENT
3119 CASTILLO RD
NEW IBERIA LA 70563

Officer/Director/Trustee Three

KENNY SIMMONS
VICE-PRESIDENT
310 WOODRICH LN
LAFAYETTE LA 70507-5206

Officer/Director/Trustee Four

THEO ANTOINE
COMPTROLLER
116 BOUTTE RD
LOREAUVILLE LA 70552

Officer/Director/Trustee Five

LEVATRICE NORA-MEULLION
FINANCIAL SECRETARY
4371 TELFAIR BLVD APT A203
CAMP SPRINGS MD 20746

Organization’s website N/A
Organization’s email KDOGSCHOLARSHIPFOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/28/09
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M42 - Automotive Safety
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 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 AMANDA SIMMONS
Signature Title CEO
Signature Date 7/29/19

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