FORM 1023-EZ for DOROTHY DOTTIE ROSS-KIWANIS CLUB OFHALLANDALE BEACH FOUNDATION INC

Field Data
EIN 81-1307899
Case Number EO-2016035-000197
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DOROTHY DOTTIE ROSS-KIWANIS CLUB OFHALLANDALE BEACH FOUNDATION INC
Organization’s Mailing Address 200 LESLIE DRIVE APT 818
City HALLANDALE BEACH
State FL
ZIP 33009-7317
Accounting period End 12
Primary contact name LEO GRACHOW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LEO GRACHOW
PRESIDENT
200 LESLIE DR APT 818
HALLANDALE BEACH FL 33009

Officer/Director/Trustee Two

JONATHAN CARRILLO
SECRETARY
410 SE 3RD ST
HALLANDALE BEACH FL 33009

Officer/Director/Trustee Three

ALAN LIPSON
TREASURER
1920 S OCEAN DR
HALLANDAKE BEACH FL 33009

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/6/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T22 - Private Independent Foundations
Organization’s purpose Charitable: Yes
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 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
Signature Title
Signature Date

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