FORM 1023-EZ for LOUISVILLE SOCIAL INNOVATION LAB INC

Field Data
EIN 84-2543529
Case Number EO-2019217-000104
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LOUISVILLE SOCIAL INNOVATION LAB INC
Organization’s Mailing Address 1035 S 4TH STREET
City LOUIVILLE
State KY
ZIP 40203
Accounting period End 12
Primary contact name NICO FERRERYA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PRANEETH GOLI
CO-EXECUTIVE DIRECTOR, BOARD MEMBER
5106 AMBER HILL PLACE
LOUISVILLE KY 40241

Officer/Director/Trustee Two

NICOLAS FERRERYA
CO-EXECUTIVE DIRECTOR, BOARD MEMBER
1035 S 4TH ST
LOUISVILLE KY 40203

Officer/Director/Trustee Three

JARUI DESAI
BOARD MEMBER
15809 NORTHVILLE PL
LOUISVILLE KY 40245

Organization’s website WWW.SIL-LOU.ORG
Organization’s email ADMIN@SIL-LOU.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/27/19
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 PRANEETH GOLI
Signature Title CO-EXECUTIVE DIRECTOR, BOARD MEMBER
Signature Date 8/3/19

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