FORM 1023-EZ for LIFE-101 INC

Field Data
EIN 81-1678777
Case Number EO-2016187-000091
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE-101 INC
Organization’s Mailing Address 6492 SHULL ROAD
City HUBER HEIGHTS
State OH
ZIP 45424
Accounting period End 12
Primary contact name ANTHONY BARWICK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANTHONY BARWICK
PRESIDENT
P O BOX 95
DAYTON OH 45401

Officer/Director/Trustee Two

DEASA NICHOLS
VICE PRESIDENT
506 MCGREFOR AVE
CINCINNATI OH 45206

Officer/Director/Trustee Three

DONNA LONG
SECRETARY
6492 SHILL ROAD
HUBER HEIGHTS OH 45424

Officer/Director/Trustee Four

JOHN MUNSON
TREASURER
289 C NORTHLAND BLVD
CINCINNATI OH 45426

Officer/Director/Trustee Five

TY STONE
BOARD ADVISOR
2 DESHLER PLACE
DAYTON OH 45405

Organization’s website TBA
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/16/2016
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B80 - Student Services, Organizations of Students
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 No
One Third Support Gifts Yes
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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