FORM 1023-EZ for LIONS DIABETES CAMP OF SOUTHERN CALIFORNIA

Field Data
EIN 83-2178185
Case Number EO-2020062-000611
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIONS DIABETES CAMP OF SOUTHERN CALIFORNIA
Organization’s Mailing Address 5481 GRAND PRIX CT
City FONTANA
State CA
ZIP 92336-0179
Accounting period End 12
Primary contact name LIDIA PETROV-JONES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LIDIA PETROV-JONES
CEO
5481 GRAND PRIX CT
FONTANA CA 92336-0179

Officer/Director/Trustee Two

MIKE JONES
SECRETARY
5481 GRAND PRIX CT
FONTANA CA 92336-0179

Officer/Director/Trustee Three

MICHELE BECKMAN
TREASURER
11934 LIANA CT
YUCAIPA CA 92399

Organization’s website LIONSDIABETESCAMP.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/11/2018
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LIDIA PETROV-JONES
Signature Title CEO
Signature Date 2/29/2020

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