FORM 1023-EZ for RX BALLROOM DANCE

Field Data
EIN 83-3614276
Case Number EO-2019087-000288
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name RX BALLROOM DANCE
Organization’s Mailing Address 28 AGAVE CT
City LADERA RANCH
State CA
ZIP 92694
Accounting period End 12
Primary contact name ERIN MELISSA DRAKE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES ROBERTS
CHAIRMAN OF THE BOARD OF DIRECTORS
3061 E LA PALMA AVE
ANAHEIM CA 92806

Officer/Director/Trustee Two

RICHARD GRAHAM
DIRECTOR
31331 COAST HWY
LAGUNA BEACH CA 92651

Officer/Director/Trustee Three

AUDREY SCHWARZBEIN
DIRECTOR
31331 COAST HWY
LAGUNA BEACH CA 92651

Officer/Director/Trustee Four

LARAINE TANZER
DIRECTOR
4530 ROXBURY ROAD
CORONA DEL MAR CA 99262

Officer/Director/Trustee Five

LYNDA ZADRA
DIRECTOR
25512 NOTTINGHAM CT
LAGUNA HILLS CA 92653

Organization’s website WWW.RXBALLROOMDANCE.COM
Organization’s email INFO@RXBALLROOMDANCE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/15/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
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 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 JAMES ROBERTS
Signature Title CHAIRMAN OF THE BOARD OF DIRECTORS
Signature Date 3/25/19

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