FORM 1023-EZ for ROLL TO SUCCESS A NONPROFIT CORPORATION

Field Data
EIN 83-3884831
Case Number EO-2019140-000161
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ROLL TO SUCCESS A NONPROFIT CORPORATION
Organization’s Mailing Address 442 KEMPTON STREET
City SPRING VALLEY
State CA
ZIP 91977
Accounting period End 12
Primary contact name STEPHEN HAWKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JACQUES THEUS
CEO
442 KEMPTON ST
SPRING VALLEY CA 91977

Officer/Director/Trustee Two

AMBER THEUS
SEC
442 KEMPTON ST
SPRING VALLEY CA 91977

Officer/Director/Trustee Three

JACQUES THEUS
CFO
442 KEMPTON ST
SPRING VALLEY CA 91977

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/14/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 JACQUES THEUS
Signature Title CFO
Signature Date 5/16/19

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