FORM 1023-EZ for LUPUS CONNECTION INC

Field Data
EIN 46-3972676
Case Number EO-2015110-000249
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LUPUS CONNECTION INC
Organization’s Mailing Address 1204 14TH AVENUE NORTH
City ST PETERSBURG
State FL
ZIP 33705-1049
Accounting period End 12
Primary contact name JOHANNA ISDAHL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOHANNA ISDAHL
EXECUTIVE DIRECTOR
1204 14TH AVENUE NORTH
ST PETERSBURG FL 33705-1049

Officer/Director/Trustee Two

MICHELE KELLER
VICE PRESIDENT-PROGRAMS OPERATION
3011 LEILA AVENUE
TAMPA FL 33611-4420

Officer/Director/Trustee Three

STEVEN WALL
DIRECTOR
4110 NO BARTLETT AVENUE
SHOREWOOD WI 53211-1921

Officer/Director/Trustee Four

NANSUBUGA NAGADYA ISDAHL
DIRECTOR
1204 14TH AVENUE NORTH
ST PETERSBURG FL 33705-1049

Officer/Director/Trustee Five

MURTIANI HENDRIWARDANI
DIRECCTOR
2222 DETROIT AVENUE - APT 102
CLEVELAND OH 44113-2453

Organization’s website LUPUSCONNECTION.NET
Organization’s email JOHANNA.ISDAHL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/18/2013
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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 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
Signature Title
Signature Date

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