FORM 1023-EZ for HEALTHY GREEN LIFE FOUNDATION

Field Data
EIN 84-4945036
Case Number EO-2020183-000302
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALTHY GREEN LIFE FOUNDATION
Organization’s Mailing Address 620 CUMBERLAND STREET
City RIVER RIDGE
State LA
ZIP 70123
Accounting period End 1
Primary contact name ROBERT SHAW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT SHAW
PRESIDENT
620 CUMBERLAND STREET
RIVER RIDGE LA 70123

Officer/Director/Trustee Two

LAJOAN WILLIAMS
VICE PRESIDENT
1725 LINCOLN AVE
MARRERO OH 70072

Officer/Director/Trustee Three

KIMBERLY TODD
DIRECTOR
29050 DETROIT RD
WESTLAKE OH 44145

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/4/2020
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B03 - Professional Societies, Associations
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 Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More Yes
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 ROBERT SHAW
Signature Title PRESIDENT
Signature Date 6/29/2020

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