FORM 1023-EZ for BURSTWAVE FOUNDATION

Field Data
EIN 86-1763317
Case Number EO-2021085-000396
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BURSTWAVE FOUNDATION
Organization’s Mailing Address 13979 CROSS COUNTY ROAD
City MINERAL
State VA
ZIP 23117
Accounting period End 12
Primary contact name SANDRA OBRIEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SANDRA OBRIEN
PRESIDENT
13979 CROSS COUNTY ROAD
MINERAL VA 23117

Officer/Director/Trustee Two

RICHARD OBRIEN
SECRETARY/TREASURER
13979 CROSS COUNTY ROAD
MINERAL VA 23117

Officer/Director/Trustee Three

JOSEPH NUNN
DIRECTOR
8132 BLAINE ROAD
RICHMOND VA 23235

Officer/Director/Trustee Four

KATHRINE JOHNSON
DIRECTOR
891 HARRIS CREEK ROAD
MINERAL VA 23117

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/24/2021
Organization Incorporation State VA
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: 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 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 SANDRA OBRIEN
Signature Title PRESIDENT
Signature Date 2/3/2021

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