FORM 1023-EZ for RICHARD BREUNIG FOUNDATION

Field Data
EIN 81-2816163
Case Number EO-2016340-000145
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name RICHARD BREUNIG FOUNDATION
Organization’s Mailing Address 5941 NUGGET CIRCLE
City HUNTINGTON BEACH
State CA
ZIP 92647
Accounting period End 4
Primary contact name MELLISSA BREUNIG 562-746-2493
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID BREUNIG
PRESIDENT
5941 NUGGET CIRCLE
HUNTINGTON BEACH CA 92647

Officer/Director/Trustee Two

MELLISSA ARRIOLA-BREUNIG
VICE PRESIDENT
5941 NUGGET CIRCLE
HUNTINGTON BEACH CA 92647

Officer/Director/Trustee Three

AMANDA HOPE BREUNIG
TREASURE
5941 NUGGET CIRCLE
HUNTINGTON BEACH CA 92647

Officer/Director/Trustee Four

NATASHA BLADE
SECRETARY
14020 YUKON AVENUE APT 101
HAWTHORNE CA 90250

Organization’s website
Organization’s email RICHARDBREUNIGFOUNDATION@OUTLOOK.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/30/2016
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: Yes
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
Signature Title
Signature Date

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