FORM 1023-EZ for HEALTHY BALANCE FOUNDATION

Field Data
EIN 83-1881757
Case Number EO-2018288-000597
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALTHY BALANCE FOUNDATION
Organization’s Mailing Address 5501 LILLEHAMMER LN APT 4101
City PARK CITY
State UT
ZIP 84098
Accounting period End 12
Primary contact name ELISABETH NICHOLE DREYER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ELISABETH NICHOLE DREYER
PRESIDENT/DIRECTOR/TREASURER
5501 LILLEHAMMER LN APT 4101
PARK CITY UT 84098

Officer/Director/Trustee Two

POTTER CLARK
DIRECTOR/SECRETARY
5501 LILLEHAMMER LN APT 4101
PARK CITY UT 84098

Officer/Director/Trustee Three

AMORETTE LAFRANCHI
DIRECTOR
5501 LILLEHAMMER LN APT 4101
PARK CITY UT 84098

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/20/18
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 ELISABETH NICHOLE DREYER
Signature Title PRESIDENT/DIRECTOR/TREASURER
Signature Date 10/12/18

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