FORM 1023-EZ for PEMBERTON SCARBOROUGH FOUNDATION

Field Data
EIN 83-4192499
Case Number EO-2019092-000021
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PEMBERTON SCARBOROUGH FOUNDATION
Organization’s Mailing Address 7692 APPLE TREE CIRCLE
City ORLANDO
State FL
ZIP 32819
Accounting period End 12
Primary contact name CHASE J SCARBOROUGH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHASE SCARBOROUGH
OFFICER
7692 APPLE TREE CIRCLE
ORLANDO FL 32819

Officer/Director/Trustee Two

BENJAMIN PEMBERTON
OFFICER
1285 S DISSTON AVE
TARPON SPRINGS FL 34689

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/29/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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 CHASE SCARBOROUGH
Signature Title OFFICER
Signature Date 3/30/19

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