FORM 1023-EZ for LOUISIANA CHI FOUNDATION

Field Data
EIN 47-2148633
Case Number EO-2015138-000284
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LOUISIANA CHI FOUNDATION
Organization’s Mailing Address 6542 FLEUR DE LIS DR
City NEW ORLEANS
State LA
ZIP 70124
Accounting period End 12
Primary contact name DAVID VICKNAIR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

THOMAS DEMPSEY
OFFICER
432 SOUTHDOWN W BLVD
HOUMA LA 70360

Officer/Director/Trustee Two

SHANE PREJEAN
TRUSTEE
9034 BOONE DR
BATON ROUGE LA 70810

Officer/Director/Trustee Three

REID AMEDEE
TRUSTEE
200 FALLOW BUCK CT
CONROE TX 77384

Officer/Director/Trustee Four

SHANE KIRKLAND
TRUSTEE
1866 BAYOU ROAD
THIBODAUX LA 70301

Officer/Director/Trustee Five

JOHN KAZUSKY
TRUSTEE
10310 SPRINTREE AVE
BATON ROUGE LA 70810

Organization’s website
Organization’s email THOMASLDEMPSEY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/19/2014
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P12 - Fund Raising and/or Fund Distribution
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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