FORM 1023-EZ for THE ERNEST AND MARILYN KUSSMAUL CHARITABLE FOUNDATION INC

Field Data
EIN 47-3401748
Case Number EO-2018171-000569
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE ERNEST AND MARILYN KUSSMAUL CHARITABLE FOUNDATION INC
Organization’s Mailing Address 85 WEST MAIN STREET SUITE 301
City BAY SHORE
State NY
ZIP 11706
Accounting period End 12
Primary contact name MICHAEL BELFORD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL BELFORD
PRESIDENT
85 WEST MAIN STREET SUITE 301
BAY SHORE NY 11706

Officer/Director/Trustee Two

ROBERT KING
TREASURER
320 CARLETON AVENUE
CENTRAL ISLIP NY 11722

Officer/Director/Trustee Three

ROBERT KING
SECRETARY
320 CARLETON AVENUE
CENTRAL ISLIP NY 11722

Organization’s website
Organization’s email MBELFORD@OPTONLINE.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/5/15
Organization Incorporation State NY
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 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 MICHAEL BELFORD
Signature Title PRESIDENT
Signature Date 6/18/18

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