FORM 1023-EZ for BREAD OF LIFE FOOD PANTRY INC

Field Data
EIN 54-2057171
Case Number EO-2017220-000159
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BREAD OF LIFE FOOD PANTRY INC
Organization’s Mailing Address 137 WEST MAIN STREET PO BOX 1284
City SATLVILLE
State VA
ZIP 24370
Accounting period End 12
Primary contact name SYLVIA CROSS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JIM JONES
CHAIRMAN
PO BOX 91
SALTVILLE VA 24370

Officer/Director/Trustee Two

BILL PAULEY
CO-CHAIRMAN
1103 WEST MAIN STREET
SALTVILLE VA 24370

Officer/Director/Trustee Three

SYLVIA CROSS
SECRETARY
19120 BELLEVUE ROAD
ABINGDON VA 24210

Officer/Director/Trustee Four

CINDY UMBURGER
TREASURER
2216 CHEY DRIVE
SALTVILLE VA 24370

Officer/Director/Trustee Five

RAYMOND CORSS
PURCHASING
30427 OLD SALTWORKS ROAD
MEADOWVIEW VA 24361

Organization’s website
Organization’s email BOLFOODPANTRY@BOLFOODPANTRY.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/22/2000
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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