FORM 1023-EZ for LIFE IMPACTERS FOUNDATION

Field Data
EIN 86-1195933
Case Number EO-2021064-002262
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIFE IMPACTERS FOUNDATION
Organization’s Mailing Address 5258 W BLOOMINGDALE AVE
City CHICAGO
State IL
ZIP 60639
Accounting period End 12
Primary contact name MICA WOODS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HARRY PENA
PRESIDENT
5258 W BLOOMINGDALE AVE
CHICAGO IL 60639

Officer/Director/Trustee Two

YOLANDA PENA
TREASURER
1856 N LECLAIRE AVENUE
CHICAGO IL 60639

Officer/Director/Trustee Three

NILDA MENENDEZ
SECRETARY
5237 N LUNA AVENUE
CHICAGO IL 60641

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/5/2020
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 HARRY PENA
Signature Title PRESIDENT
Signature Date 1/14/2021

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