FORM 1023-EZ for MERCY LIFE SOCIETY

Field Data
EIN 82-3375679
Case Number EO-2017333-000358
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MERCY LIFE SOCIETY
Organization’s Mailing Address 49113 ROSE TERRACE
City FREMONT
State CA
ZIP 94539
Accounting period End 12
Primary contact name NEERAJ BHATIA CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHIVAJI ADURTHY
CEO
49113 ROSE TERRACE
FREMONT CA 94539

Officer/Director/Trustee Two

RAMPRASAD SRIPADA
SECRETARY
165 KIELY BLVD
SANTA CLARA CA 95051

Officer/Director/Trustee Three

ASHOK SRINIVASA MURTHY
CFO
4690 PHEBE AVE
FREMONT CA 94555

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/30/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T99 - Philanthropy, Voluntarism, and Grantmaking Foundations N.E.C.
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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