FORM 1023-EZ for MIXED NATION FOUNDATION

Field Data
EIN 84-3631425
Case Number EO-2019316-000384
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MIXED NATION FOUNDATION
Organization’s Mailing Address 8302 DRAVO CIR
City LOUISVILLE
State KY
ZIP 40220
Accounting period End 12
Primary contact name LUKE WHITEHEAD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LUKE WHITEHEAD
DIRECTOR
8302 DRAVO CIRCLE
LOUISVILLE KY 40220

Officer/Director/Trustee Two

JEFFREY GORSKI
DIRECTOR
821 SOUTH SECOND STREET
LOUISVILLE KY 40203

Officer/Director/Trustee Three

ANTECIA WHITEHEAD
DIRECTOR
8302 DRAVO CIR
LOUISVILLE KY 40220

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/8/19
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A23 - Cultural, Ethnic Awareness
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 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 LUKE WHITEHEAD
Signature Title DIRECTOR
Signature Date 11/8/19

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