FORM 1023-EZ for JIVAN FOUNDATION

Field Data
EIN 47-3855925
Case Number EO-2018204-000322
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JIVAN FOUNDATION
Organization’s Mailing Address 1529 STAMPMILL WAY
City LAWRENCEVILLE
State GA
ZIP 30043-6288
Accounting period End 12
Primary contact name KAMLESH PATEL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KAMLESH PATEL
EXECUTIVE DIRECTOR
1529 STAMPMILL WAY
LAWRENCEVILLE GA 30043-6288

Officer/Director/Trustee Two

ALETHA CHAPPELEAR
PROGRAM COORDINATOR
1096-A HERNDON ST NW
ATLANTA GA 30318-5202

Officer/Director/Trustee Three

FAISAL BAYERO
FINANCIAL DIRECTOR
1100 VIA LUGANO CIR 310
BOYNTON BEACH FL 33436-7188

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/2/18
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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 Yes
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 KAMLESH PATEL
Signature Title EXECUTIVE DIRECTOR
Signature Date 7/20/18

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