FORM 1023-EZ for SHEFA LIFE

Field Data
EIN 84-4301953
Case Number EO-2020017-000277
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SHEFA LIFE
Organization’s Mailing Address 210 W CONTINENTAL RD STE 216B
City GREEN VALLEY
State AZ
ZIP 85622
Accounting period End 12
Primary contact name DR LUTISSUA BALLARD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LUTISSUA BALLARD
PRESIDENT
210 W CONTINENTAL RD STE 216B
GREEN VALLEY AZ 85622

Officer/Director/Trustee Two

CHRISTOPHER BALLARD
SECRETARY
210 W CONTINENTAL RD STE 216B
GREEN VALLEY AZ 85622

Officer/Director/Trustee Three

STEPHANIE FUMI-HANCOCK
BOARD MEMBER
210 W CONTINENTAL RD STE 216B
GREEN VALLEY AZ 85622

Officer/Director/Trustee Four

FRED WIGGINS
BOARD MEMBER
210 W CONTINENTAL RD STE 216B
GREEN VALLEY AZ 85622

Officer/Director/Trustee Five

VEONA STEVENS-ROSA
TREASURER
210 W CONTINENTAL RD STE 216B
GREEN VALLEY AZ

Organization’s website WWW.SHEFALIFE.ORG
Organization’s email DRLBALLARD@SHEFALIFE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/27/2019
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F32 - Community Mental Health Center
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LUTISSUA BALLARD
Signature Title PRESIDENT
Signature Date 1/15/2020

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