FORM 1023-EZ for ELITE BRAIN FITNESS

Field Data
EIN 85-2325093
Case Number EO-2020302-000206
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ELITE BRAIN FITNESS
Organization’s Mailing Address PO BOX 20554
City RENO
State NV
ZIP 89515
Accounting period End 9
Primary contact name SHARAYAH ALTHAGE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHARAYAH ALTHAGE
PRESIDENT
1691 ASHWORTH CT
RENO NV 89521

Officer/Director/Trustee Two

CESARE CALDWELL
SECRETARY
2540 LYMBERY STREET
RENO NV 89509

Officer/Director/Trustee Three

JACKIE EELKEMA
TREASURER
10641 CHURCH STREET
RANCHO CUCAMONGA CA 91730

Officer/Director/Trustee Four

MIKE GILL
DIRECTOR
23603 VIA PRIMERO
VALENCIA CA 91354

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/2020
Organization Incorporation State NV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 MIKE GILL
Signature Title DIRECTOR
Signature Date 10/26/2020

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