FORM 1023-EZ for KBL FOUNDATION

Field Data
EIN 83-2106940
Case Number EO-2019140-000170
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KBL FOUNDATION
Organization’s Mailing Address 2848 HIDEAWAY RD
City FAIRFAX
State VA
ZIP 22031
Accounting period End 12
Primary contact name KALVIN LEE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KALVIN LEE
PRESIDENT
3144 GUYSBOROUGH DR
FAIRFAX VA 22031

Officer/Director/Trustee Two

CINDY PARK
VICE PRESIDENT
2848 HIDEAWAY RD
FAIRFAX VA 22031

Officer/Director/Trustee Three

JESSIE KIM
SECRETARY/TREASURER
9204 AFTON CT
MANASSAS VA 20110

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/4/18
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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 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 KALVIN LEE
Signature Title PRESIDENT
Signature Date 5/16/19

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