FORM 1023-EZ for STAY ALIVE INC

Field Data
EIN 83-1818556
Case Number EO-2019036-000206
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name STAY ALIVE INC
Organization’s Mailing Address 6029 W WARWICK AVENUE
City CHICAGO
State IL
ZIP 60634
Accounting period End 12
Primary contact name DAWN EPTING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RYNE BANDOLIK
PRESIDENT
1306 N SPRINGFIELD AVENUE
CHICAGO IL 60651

Officer/Director/Trustee Two

CALEB BELTRAN
TREASURER
6029 W WARWICK AVENUE
CHICAGO IL 60634

Officer/Director/Trustee Three

RUBEN VARGAS
VICE PRESIDENT
2066 N WESTERN AVENUE
CHICAGO IL 60647

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/15/19
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 Yes
Compensation of Officer director trustee Yes
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 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 RYNE BANDOLIK
Signature Title PRESIDENT
Signature Date 1/18/19

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