FORM 1023-EZ for 490 FOUNDATION INC

Field Data
EIN 82-2018889
Case Number EO-2017188-000170
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name 490 FOUNDATION INC
Organization’s Mailing Address 333 N ALABAMA ST SUITE 350
City INDIANAPOLIS
State IN
ZIP 46204
Accounting period End 12
Primary contact name DON WILLIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DON WILLIS
PRESIDENT
17007 HARBINGER CT
NOBLESVILLE IN 46062

Officer/Director/Trustee Two

JOHN CERNERO
MEMBER
16162 CAREY RD
WESTFIELD IN 46074

Officer/Director/Trustee Three

ANITA PREWITT
MEMBER
10119 N COUNTY RD 1150 E
SEYMOUR IN 47274

Organization’s website 490FOUNDATION.COM
Organization’s email 490FOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/27/2017
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B80 - Student Services, Organizations of Students
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 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 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
Signature Title
Signature Date

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