FORM 1023-EZ for LIVE HEALTHY LYNCHBURG

Field Data
EIN 83-2310456
Case Number EO-2019029-000524
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIVE HEALTHY LYNCHBURG
Organization’s Mailing Address 4849 FORT AVE SUITE B
City LYNCHBURG
State VA
ZIP 24502
Accounting period End 12
Primary contact name KEITH ANDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICHARD LANE
PRESIDENT
103 VILLAGE ROAD
LYNCHBURG VA 24502

Officer/Director/Trustee Two

KEITH ANDERSON
VICE PRESIDENT
3413 WILSON AVENUE
LYNCHBURG VA 24501

Officer/Director/Trustee Three

JOY COVER
SECRETARY
210 ASH STREET
LYNCHBURG VA 24503

Officer/Director/Trustee Four

RACHEL GAGEN
DIRECTOR OF MEDIA CORRESPONDENCE
1212 MCCONVILLE RD
LYNCHBURG VA 24502

Organization’s website HTTP://WWW.LIVEHEALTHYLYNCHBURG.COM/
Organization’s email LIVEHEALTHYLYNCHBURGUP@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/14/18
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
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 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 KEITH ANDERSON
Signature Title VICE PRESIDENT
Signature Date 12/18/18

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