FORM 1023-EZ for LIVE FOR LEVI FOUNDATION

Field Data
EIN 82-2741954
Case Number EO-2017256-000349
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIVE FOR LEVI FOUNDATION
Organization’s Mailing Address 987 EAST 1380 SOUTH
City SPANISH FORK
State UT
ZIP 84660
Accounting period End 12
Primary contact name PATTIE S CHRISTENSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PATRICE SAMPSON
DIRECTOR/TRUSTEE
987 E 1380 S
SPANISH FORK UT 84660

Officer/Director/Trustee Two

KRISTEN CHASE
DIRECTOR/TRUSTEE
425 NORTH 490 EAST
DELTA UT 84624

Officer/Director/Trustee Three

SCOTT AMUSSEN
DIRECTOR/TRUSTEE
915 EAST 1170 NORTH
PLEASANT GROVE UT 84062

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/11/2017
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G98 - Pediatrics
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 Yes
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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