FORM 1023-EZ for A CHANCE 4 LIFE

Field Data
EIN 81-4976196
Case Number EO-2017039-000169
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name A CHANCE 4 LIFE
Organization’s Mailing Address 941 REV JAMES A POLITE AVE
City BRONX
State NY
ZIP 10459-3001
Accounting period End 12
Primary contact name MALOBE SAMPSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MALOBE SAMPSON
PRESIDENT
123 VALENTINE LANE APT 2G
YONKERS NY 10705-3429

Officer/Director/Trustee Two

KIMATHI CHOMA
SECRETARY
2812 BROOKVILLE DRIVE
MANHATTAN KS 66502-8428

Officer/Director/Trustee Three

BERNARD FORBES
TREASURER
816 EAST 226 STREET APT 4
BRONX NY 10466-4441

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/20/2016
Organization Incorporation State NY
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: 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 Yes
Donation of funds No
Conducting Activities Outside of United States Yes
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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