FORM 1023-EZ for HEALTHY LIVING FOUNDATION INC

Field Data
EIN 84-1820266
Case Number EO-2019158-000246
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALTHY LIVING FOUNDATION INC
Organization’s Mailing Address 10418 K NORTH MAIN STREET
City ARCHDALE
State NC
ZIP 27263
Accounting period End 12
Primary contact name RASHAD RICHARDSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RASHAD RICHARDSON
DIRECTOR
220 KINVIEW DRIVE
ARCHDALE NC 27263

Officer/Director/Trustee Two

TERRELL MORTON
DIRECTOR
1115 KENNESAW RIDGE ROAD UNIT 101
COLUMBIA MO 65202

Officer/Director/Trustee Three

BRENTON BOYCE
DIRECTOR
1119 GREENE STREET
GREENSBORO NC 27401

Officer/Director/Trustee Four

CYNTHIA PITCHFORD
DIRECTOR
PO BOX 251
ENFIELD NC 27823

Officer/Director/Trustee Five

KYLE GREEN
DIRECTOR
17006 WESTINGTON ROAD
MOSELY VA 23120

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/2/19
Organization Incorporation State NC
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 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 RASHAD RICHARDSON
Signature Title DIRECTOR
Signature Date 6/5/19

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