FORM 1023-EZ for LIFEBALL

Field Data
EIN 84-3690093
Case Number EO-2019345-000230
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIFEBALL
Organization’s Mailing Address 8218 NE 198TH ST
City KENMORE
State WA
ZIP 98028-2086
Accounting period End 12
Primary contact name JOSHUA FERGUSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSHUA FERGUSON
PRESIDENT/CEO
8218 NE 198TH ST
KENMORE WA 98028-2086

Officer/Director/Trustee Two

STEVELAN HARPER
SECRETARY
1454 162ND AVE APT 48
SAN LEANDRO CA 94578-2149

Officer/Director/Trustee Three

ANTONIO PENNYMAN
TREASURER/CFO
11588 S WOODHAMPTON DR
SANDY UT 84092-7122

Organization’s website N/A
Organization’s email LIFEBALLTEAM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/12/2019
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 JOSHUA FERGUSON
Signature Title PRESIDENT/CEO
Signature Date 12/9/2019

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