FORM 1023-EZ for DETECTIVE BRIAN SMILES SIMONSEN MEMORIAL FOUNDATION INC

Field Data
EIN 83-4601875
Case Number EO-2019126-000382
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DETECTIVE BRIAN SMILES SIMONSEN MEMORIAL FOUNDATION INC
Organization’s Mailing Address 30 DONNA DRIVE
City CALVERTON
State NY
ZIP 11933
Accounting period End 12
Primary contact name LAURA I DUNATHAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LEANNE SIMONSEN
DIRECTOR
30 DONNA DRIVE
CALVERTON NY 11933

Officer/Director/Trustee Two

MICHAEL LOJKO
DIRECTOR
22 BROAD HOLLOW ROAD
HAMPTON BAYS NY 11946

Officer/Director/Trustee Three

LINDA SIMONSEN
DIRECTOR
1407 MIDDLE ROAD UNIT 35
CALVERTON NY 11933

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/17/19
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LEANNE SIMONSEN
Signature Title DIRECTOR
Signature Date 5/2/19

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