FORM 1023-EZ for BASIC LIFE SOLUTIONS INC

Field Data
EIN 82-3729128
Case Number EO-2018274-000374
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BASIC LIFE SOLUTIONS INC
Organization’s Mailing Address 310 MODEST STREET
City LAKELAND
State FL
ZIP 33805
Accounting period End 12
Primary contact name VERONICA ROUNTREE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VERONICA ROUNTREE
PRESIDENT
310 MODEST STREET
LAKELAND FL 33805

Officer/Director/Trustee Two

LAURIE HOLLAND
TREASURER
320 S IOWA AVENUE APT 5
LAKELAND FL 33801

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W01 - 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 Yes
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 Yes
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 LAURIE HOLLAND
Signature Title TREASURER
Signature Date 9/28/18

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