FORM 1023-EZ for LIFELINE FOUNDATION INC

Field Data
EIN 27-5460521
Case Number EO-2017257-000184
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFELINE FOUNDATION INC
Organization’s Mailing Address 1550 TERRELL MILL RD 18B
City MARIETTA
State GA
ZIP 30067
Accounting period End 12
Primary contact name CYNTHIA SANON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ZIVIAN JOHNSON
CFO
2067 ROCKHAVEN DR
DECATUR GA 30032

Officer/Director/Trustee Two

VLADIMIR MORICETTE
TREASURER
1550 TERRELL MILL RD 18B
MARIETTA GA 30067

Officer/Director/Trustee Three

CYNTHIA SANON
PRESIDENT
1550 TERRELL MILL 18B
MARIETTA GA 30067

Organization’s website LLFND.ORG
Organization’s email LLFND17@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/10/2011
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity Yes
Disaster relief assistance Yes
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
Signature Title
Signature Date

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