FORM 1023-EZ for KIDNEY LIFE FOUNDATION INC

Field Data
EIN 46-5057561
Case Number EO-2016034-000087
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KIDNEY LIFE FOUNDATION INC
Organization’s Mailing Address 5320 MECCA AVENUE
City TARZANA
State CA
ZIP 91356-4122
Accounting period End 12
Primary contact name BROOK BECKLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BROOK BECKLEY
PRESIDENT, CEO, FOUNDER
5320 MECCA AVENUE
TARZANA CA 91356-4122

Officer/Director/Trustee Two

ERICA RIOS
V.P. OF MARKETING, SECRETARY
5320 MECCA AVENUE
TARZANA CA 91356-4122

Officer/Director/Trustee Three

SANDRA BECKLEY
V.P. OF DEV., TREASURER
5320 MECCA AVENUE
TARZANA CA 91356-4122

Officer/Director/Trustee Four

DOUGLAS HAYES
DIRECTOR
5320 MECCA AVENUE
TARZANA CA 91356-4122

Officer/Director/Trustee Five

PAMELA TROVATTEN
DIRECTOR
5320 MECCA AVENUE
TARZANA CA 91356-4122

Organization’s website WWW.KIDNEYLIFE.ORG
Organization’s email INFO@KIDNEYLIFE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/8/2013
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G44 - Kidney Disease
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 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
Signature Title
Signature Date

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