FORM 1023-EZ for SARAH JANE BENTLEY FOUNDATION

Field Data
EIN 85-2803935
Case Number EO-2021085-000680
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SARAH JANE BENTLEY FOUNDATION
Organization’s Mailing Address 12 POPLAR ST
City RICHLAND
State PA
ZIP 17087
Accounting period End 12
Primary contact name HERMAN L BENTLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HERMAN BENTLEY
CHIEF EXECUTIVE OFFICER
12 POPLAR ST
RICHLAND PA 17087

Officer/Director/Trustee Two

CHARLES LEVY
TRUSTEE
2801 PENBROOK AVE
HARRISBURG PA 17103

Officer/Director/Trustee Three

SABRINA SILEERT
SECRETARY
1540 8TH ST
WYANDOTTE MI 48192

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/14/2021
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
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 Yes
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name HERMAN BENTLEY
Signature Title CHIEF EXECUTIVE OFFICER
Signature Date 2/4/2021

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