FORM 1023-EZ for CARIBBEAN BREEZE COMMUNITY OUTREACH

Field Data
EIN 86-2707410
Case Number EO-2021099-001175
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CARIBBEAN BREEZE COMMUNITY OUTREACH
Organization’s Mailing Address 8740 CRUSHEEN WAY
City SACRAMENTO
State CA
ZIP 95828
Accounting period End 12
Primary contact name AMELIA KELLY-SEMPER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AMELIA KELLY-SEMPER
PRESIDENT
8740 CRUSHEEN WAY
SACRAMENTO CA 95828

Officer/Director/Trustee Two

VINCENT SEMPER
VICE PRESIDENT
8740 CRUSHEEN WAY
SACRAMENTO CA 95828

Officer/Director/Trustee Three

GLENDA SMITH
SECRETARY
8740 CRUSHEEN WAY
SACRAMENTO CA 95828

Officer/Director/Trustee Four

SHARON SMITH
DIRECTOR
8740 CRUSHEEN WAY
SACRAMENTO CA 95828

Officer/Director/Trustee Five

DAVID ROYSTER
DIRECTOR
8740 CRUSHEEN WAY
SACRAMENTO CA 95828

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/24/2021
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
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 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 Yes
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 AMELIA KELLY-SEMPER
Signature Title PRESIDENT
Signature Date 3/18/2021

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