FORM 1023-EZ for THE ANTWAUN ROLLERSON FOUNDATION

Field Data
EIN 47-4700261
Case Number EO-2015327-000208
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE ANTWAUN ROLLERSON FOUNDATION
Organization’s Mailing Address 5502 N 50TH AVE
City OMAHA
State NE
ZIP 68104
Accounting period End 12
Primary contact name KIMMIETH GORDON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NATASHA ROLLERSON
TRUSTEE
1020 RALEIGH DR APT 2007
CARROLLTON TX 75007

Officer/Director/Trustee Two

KIMMIETH GORDON
TREASURER
1020 RALEIGH DR APT 2007
CARROLLTON TX 75007

Officer/Director/Trustee Three

ILENE ROLLERSON
REGISTERED AGENT
5502 N 50TH AVE
OMAHA NE 68104

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/4/2015
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W01 - Alliance/Advocacy Organizations
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
Signature Title
Signature Date

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