FORM 1023-EZ for GALLINESS FOUNDATION INC

Field Data
EIN 86-3720412
Case Number EO-2021272-000342
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name GALLINESS FOUNDATION INC
Organization’s Mailing Address 13160 MUSICMASTER DR
City SILVER SPRING
State MD
ZIP 20904
Accounting period End 12
Primary contact name FATMATA KHELLA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FATMATA KHELLA
EXECUTIVE DIRECTOR
13160 MUSICMASTER DR
SILVER SPRING MD 20904

Officer/Director/Trustee Two

TINYA SENSIE
TREASURER
13160 MUSIC MASTER DR
SILVER SPRING MD 20904

Officer/Director/Trustee Three

FRANCIS SAMBA
SECRETARY
10620 LARKSONG COURT
MANASSAS VA 20111

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/15/2021
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 Yes
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 FATMATA KHELLA
Signature Title EXECUTIVE DIRECTOR
Signature Date 9/27/2021

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