FORM 1023-EZ for FORMA KIDS FOUNDATION

Field Data
EIN 90-0992912
Case Number EO-2014282-000444
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FORMA KIDS FOUNDATION
Organization’s Mailing Address 1908 OLYMPIC BLVD
City WALNUT CREEK
State CA
ZIP 94596
Accounting period End 12
Primary contact name ROBERT JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT JACKSON
C.E.O
20 SARA LN
ALAMO CA 94507-7381

Officer/Director/Trustee Two

MANDANA JAMSHIDNEJAD
C.F.O
20 SARA LN
ALAMO CA 94507-7381

Officer/Director/Trustee Three

JOHN JACKSON
SECRETARY
1908 OLYMPIC BLVD
WALNUT CREEK CA 94596-5023

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/15/2013
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T23 - Private Operating Foundations
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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