FORM 1023-EZ for LSB FOUNDATION

Field Data
EIN 85-1436928
Case Number EO-2020188-000691
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LSB FOUNDATION
Organization’s Mailing Address 1111 HOWE AVE STE 305
City SACRAMENTO
State CA
ZIP 95823
Accounting period End 12
Primary contact name MAURICE BURNETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MAURICE BURNETT
DIRECTOR
5321 NAVIGATION CT
FAIR OAKS CA 95628

Officer/Director/Trustee Two

CARNETTE BURNETT
DIRECTOR
5321 NAVIGATION CT
FAIR OAKS CA 95628

Officer/Director/Trustee Three

ASHLEY KARIM-KINCEY
DIRECTOR
1763 HIGHLANDS VIEW DR
SMYRNA GA 30082

Officer/Director/Trustee Four

KIRSTEN ATKINSON
DIRECTOR
17401 RAYMER ST
SHERWOOD FOREST CA 91325

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/18/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
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 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 MAURICE BURNETT
Signature Title DIRECTOR
Signature Date 7/2/2020

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