FORM 1023-EZ for LIFE HEALTH AND WELLNESS CENTER INC

Field Data
EIN 82-1934843
Case Number EO-2017208-000267
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE HEALTH AND WELLNESS CENTER INC
Organization’s Mailing Address 195 N MAIN ST
City ANSONIA
State CT
ZIP 06401
Accounting period End 12
Primary contact name LESLIE YOUNGBLOOD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LESLIE YOUNGBLOOD
MEMBER
5225 MAIN ST
TRUMBULL CT 06611

Officer/Director/Trustee Two

SHARON GIEGER
MEMBER
21 DAYTON ST
MILFORD CT 06461

Officer/Director/Trustee Three

PATRICIA MCLEOD
MEMBER
199 N MAIN ST
ANSONIA CT 06611

Officer/Director/Trustee Four

TIKENYA YOUNGBLOOD
MEMBER
230 EVERETT ST
STRATFORD CT 06615

Officer/Director/Trustee Five

CHRISTINE BOULWARE
MEMBER
46 CHALMER AVE
BRIDGEPORT CT 06604

Organization’s website
Organization’s email MSLKY65@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/13/2017
Organization Incorporation State CT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
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
Signature Title
Signature Date

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