FORM 1023-EZ for BOURNE BLESSED FOUNDATION

Field Data
EIN 85-0660857
Case Number EO-2020113-000297
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BOURNE BLESSED FOUNDATION
Organization’s Mailing Address 2360 HAYES AVE
City LONG BEACH
State CA
ZIP 90810
Accounting period End 12
Primary contact name ANDREW BOURNE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KENDRICK BOURNE
PRESIDENT
4949 MARIE DEBARTOLO WAY
SANTA CLARA CA 95054

Officer/Director/Trustee Two

ANDREW BOURNE
VICE- PRESIDENT
7617 SE 157TH AVE
PORTLAND OR 97238

Officer/Director/Trustee Three

SOLOMON LEIFI
SECRETARY
2360 HAYES AVE
LONG BEACH CA 90810

Officer/Director/Trustee Four

TYLER WALKER
TREASURE
99 VISTA MONTANA
SAN JOSE CA 95134

Officer/Director/Trustee Five

LUISA TURNER
OFFICERS
390 S EIGHT ST
SAN JOSE CA 95112

Organization’s website BOURNEBLESSEDFOUNDATION.ORG
Organization’s email ANDREWBOURNEBLESSED@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/13/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B90 - Educational Services and Schools - Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: Yes
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 Yes
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 KENDRICK BOURNE
Signature Title PRESIDENT
Signature Date 4/20/2020

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