FORM 1023-EZ for LIFELONG HEALTH INCORPORATED

Field Data
EIN 46-5700488
Case Number EO-2017278-000422
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFELONG HEALTH INCORPORATED
Organization’s Mailing Address 151 MILL STREET
City GRASS VALLEY
State CA
ZIP 95945
Accounting period End 12
Primary contact name EILEEN HANCOCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EILEEN HANCOCK
CEO
151 MILL STREET
GRASS VALLEY CA 95945

Officer/Director/Trustee Two

SUMMER LUJAN
SECRETARY
151 MILL STREET
GRASS VALLEY CA 95945

Officer/Director/Trustee Three

EILEEN HANCOCK
CFO
151 MILL STREET
GRASS VALLEY CA 95945

Organization’s website WWW.LIFELONGHEALTHINCORPORATED.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/10/2014
Organization Incorporation State CA
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 Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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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