FORM 1023-EZ for THE ORIGIN FUND

Field Data
EIN 35-2707263
Case Number EO-2021160-000303
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE ORIGIN FUND
Organization’s Mailing Address 13425 VENTURA BLVD 200
City SHERMAN OAKS
State CA
ZIP 91423
Accounting period End 12
Primary contact name AMANDA PARACUELLOS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEANNETTE SANDOVAL
DIRECTOR AND TREASURER
13425 VENTURA BLVD 200
SHERMAN OAKS CA 91423

Officer/Director/Trustee Two

HEATHER JEFFCOAT
DIRECTOR AND PRESIDENT
13425 VENTURA BLVD 200
SHERMAN OAKS CA 91423

Officer/Director/Trustee Three

MARY SHRIVER
DIRECTOR AND SECRETARY
13425 VENTURA BLVD 200
SHERMAN OAKS CA 91423

Organization’s website WWW.THEORIGINFUND.ORG
Organization’s email FOUNDER@THEORIGINFUND.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/8/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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 Yes
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
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 HEATHER JEFFCOAT
Signature Title DIRECTOR AND PRESIDENT
Signature Date 6/7/2021

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