FORM 1023-EZ for THE SAM AND MARIE FOUNDATION

Field Data
EIN 85-2911182
Case Number EO-2020254-000465
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE SAM AND MARIE FOUNDATION
Organization’s Mailing Address 17836 BELLFLOWER BLVD
City BELLFLOWER
State CA
ZIP 90706
Accounting period End 12
Primary contact name TRINA SIMMONS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TRINA SIMMONS
PRESIDENT
9840 CEDAR ST APT 3
BELLFLOWER CA 90706

Officer/Director/Trustee Two

SHEILA JONES
VICE PRESIDENT
1867 W 94TH PL
LOS ANGELES CA 90047

Officer/Director/Trustee Three

RONNESHA PENNYWELL
SECRETARY
1867 W 94TH PL
LOS ANGELES CA 90047

Officer/Director/Trustee Four

NAJAH HASAN
TREASURY
240 W QUEEN STREET UNIT 6
INGLEWOOD CA 90301

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/3/2020
Organization Incorporation State CA
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 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 TRINA SIMMONS
Signature Title PRESIDENT
Signature Date 9/8/2020

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