FORM 1023-EZ for SUSTAINED LIFE INC

Field Data
EIN 83-2456608
Case Number EO-2019073-000493
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SUSTAINED LIFE INC
Organization’s Mailing Address 6920 BARCLAY DRIVE
City FREDERICKSBURG
State VA
ZIP 22407-2078
Accounting period End 12
Primary contact name SOPHIA BLAKE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SOPHIA BLAKE
PRESIDENT
6920 BARCLAY DRIVE
FREDERICKSBURG VA 22407-2078

Officer/Director/Trustee Two

MAYRON SHUMPERT
VICE PRESIDENT
11306 SILVERLEAF LANE
FREDERICKSBURG VA 22407-7423

Officer/Director/Trustee Three

LATISHA WOLDEMICHAEL
SECRETARY
6115 BLACK OAK DRIVE
FREDERICKSBURG VA 22407-9241

Officer/Director/Trustee Four

RODNEY BLAKE
TREASURER
6920 BARCLAY DRIVE
FREDERICKSBURG VA 22407-2078

Organization’s website WWW.SUSTAINED-LIFE.ORG
Organization’s email SLBLAKE@SUSTAINED-LIFE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/16/19
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K40 - Nutrition Programs
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SOPHIA BLAKE
Signature Title PRESIDENT
Signature Date 3/12/19

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