FORM 1023-EZ for LARSON LEGACY FOUNDATION

Field Data
EIN 84-6417045
Case Number EO-2019364-000190
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LARSON LEGACY FOUNDATION
Organization’s Mailing Address 2222 GRAINGER PKWY
City LINCOLN
State NE
ZIP 68512
Accounting period End 12
Primary contact name CHAD EUGENE LARSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHAD EUGENE LARSON
TRUSTEE
2222 GRAINGER PKWY
LINCOLN NE 68512

Organization’s website
Organization’s email LARSON.CHIRO@YAHOO.COM
Organization Incorporated
Organization trust Yes
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2019
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T20 - Private Grantmaking Foundations
Organization’s purpose Charitable: Yes
Religious: Yes
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 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 CHAD EUGENE LARSON
Signature Title TRUSTEE
Signature Date 12/26/2019

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