FORM 1023-EZ for BURTON BOUIE FOUNDATION INC

Field Data
EIN 82-3930643
Case Number EO-2018171-000331
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BURTON BOUIE FOUNDATION INC
Organization’s Mailing Address 113 JEFFREY PL
City SMYRNA
State GA
ZIP 30082
Accounting period End 12
Primary contact name KERSA POTTS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAUREN LOPEZ
OFFICER
3763 GLOUCESTER DR
TUCKER GA 30084

Officer/Director/Trustee Two

ANGEL JACKSON
ADMINISTRATOR
1200 E 10TH ST
WEST POINT GA 31833

Officer/Director/Trustee Three

KEVIN COTRELL
TREASURER
2124 SILAS WAY
ATLANTA GA 30318

Officer/Director/Trustee Four

KERSA POTTS
DIRECTOR
113 JEFFREY PL
SMYRNA GA 30082

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/18/17
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B40 - Higher Education Institutions
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 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 KERSA POTTS
Signature Title DIRECTOR
Signature Date 6/6/18

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