FORM 1023-EZ for MIDDLEBROOK FOUNDATION INC

Field Data
EIN 83-0642986
Case Number EO-2018334-000218
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MIDDLEBROOK FOUNDATION INC
Organization’s Mailing Address 820 EAST ST MARY BOULEVARD
City LAFAYETTE
State LA
ZIP 70503
Accounting period End 12
Primary contact name JOHN R REDD III CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BARRY SALLINGER
DIRECTOR
820 EAST ST MARY BOULEVARD
LAFAYETTE LA 70503

Officer/Director/Trustee Two

ADRIEN MIDDLEBROOK
PRESIDENT
436 CLAY RIDGE DRIVE
LAFAYETTE LA 70592

Officer/Director/Trustee Three

ALLYSON PREJEAN
SECRETARY
820 EAST ST MARY BOULEVARD
LAFAYETTE LA 70503

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/14/17
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other 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 Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name BARRY SALLINGER
Signature Title DIRECTOR
Signature Date 11/28/18

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