FORM 1023-EZ for LIFE BALANCE WELLNESS INSTITUTE

Field Data
EIN 47-5270432
Case Number EO-2015286-000040
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE BALANCE WELLNESS INSTITUTE
Organization’s Mailing Address 4426 HUGH HOWELL RD SUITE B194
City TUCKER
State GA
ZIP 30084
Accounting period End 12
Primary contact name SHANESHA BROOKS-TATUM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

STACY SCOTT
CHAIR
211 E BALTIMORE ST
JACKSON TN 38301

Officer/Director/Trustee Two

ANGELA HARRINGTON RICE
VICE CHAIR
110 LAFAYETTE DR
FAYETTEVILLE GA 30214

Officer/Director/Trustee Three

ROSALIND EDOCHIE
TREASURER
P O BOX 870713
STONE MOUNTAIN GA 30087

Officer/Director/Trustee Four

CASSANDRA JACKSON
SCRETARY
1751 MORSON RD
JACKSON MS 39209

Officer/Director/Trustee Five

SHANESHA BROOKS-TATUM
DIRECTOR
4426 HUGH HOWELL RD B194
TUCKER GA 30084

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/25/2015
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
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 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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