FORM 1023-EZ for ACTIVELY AGING INC

Field Data
EIN 47-1400544
Case Number EO-2014232-000077
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ACTIVELY AGING INC
Organization’s Mailing Address 2009 PORTERFIELD WAY UNIT C
City UPLAND
State CA
ZIP 91786
Accounting period End 12
Primary contact name DELORES SIMPSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DELORES SIMPSON
PRESIDENT
2009 PORTERFIELD WAY UNIT C
UPLAND CA 91786

Officer/Director/Trustee Two

RAHDRANAE TAYLOR
DIRECTOR
2009 PORTERFIELD WAY
UPLAND CA 91786

Officer/Director/Trustee Three

SHATAWNEE ROBINSON
DIRECT
2009 PORTERFIELD WAY UNIT C
UPLAND CA 91786

Officer/Director/Trustee Four

CATHERINE EKANAM
DIRECTOR
2009 PORTERFIELD WAY UNIT C
UPLAND CA 91786

Officer/Director/Trustee Five

RON MC CALL
DIRECTOR
2009 PORTERFIELD WAY UNIT C
UPLAND CA 91786

Organization’s website
Organization’s email DELORIS501C3@OUTLOOK.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/3/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P81 - Senior Centers, Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 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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