FORM 1023-EZ for SAGE CASEY FOUNDATION

Field Data
EIN 83-2529183
Case Number EO-2019057-000466
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SAGE CASEY FOUNDATION
Organization’s Mailing Address 1137 COPELAND CREEK DRIVE
City ROHNERT PARK
State CA
ZIP 94928
Accounting period End 12
Primary contact name KIMBERLY ELWELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KIMBERLY ELWELL
TREASURER
1137 COPELAND CREEK DRIVE
ROHNERT PARK CA 94928

Officer/Director/Trustee Two

KASEY HILLIER
PRESIDENT
1716 CASITA COURT
SANTA ROSA CA 95409

Officer/Director/Trustee Three

NICK PULLEY
SECRETARY
6810 NOLAN ROAD
FORESTVILLE CA 95436

Organization’s website WWW.SAGECASEYFOUNDATION.COM
Organization’s email SAGECASEYFOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/11/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O99 - Youth Development 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 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name KIMBERLY ELWELL
Signature Title TREASURER
Signature Date 2/24/19

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