FORM 1023-EZ for THE BELLA VIDA FOUNDATION

Field Data
EIN 27-4535464
Case Number EO-2019092-000472
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE BELLA VIDA FOUNDATION
Organization’s Mailing Address 1403 CENTINELA AVENUE
City INGLEWOOD
State CA
ZIP 90302
Accounting period End 12
Primary contact name JERRY C JOHNSON SR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JERRY C JOHNSON SR
CEO
1403 CENTINELA AVENUE
INGLEWOOD CA 90302

Officer/Director/Trustee Two

JESSICA JOHNSON
SECRETARY
1403 CENTINELA AVENUE
INGLEWOOD CA 90302

Officer/Director/Trustee Three

ANGELA JOHNSON
CFO
1403 CENTINELA AVENUE
INGLEWOOD CA 90302

Officer/Director/Trustee Four

CLINTON A LEWIS SR
BOARD OF DIRECTORS
249 N BRAND BLVD SUITE 431
GLENDALE CA 91203

Officer/Director/Trustee Five

LEAH HARDEN
BOARD OF DIRECTORS
4340 10TH AVENUE
LOS ANGELES CA 90008

Organization’s website
Organization’s email BELLAVIDAFOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/11/11
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S01 - Alliance/Advocacy Organizations
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 Yes
Correctness Declaration Yes
Signature Name JERRY C JOHNSON SR
Signature Title CEO
Signature Date 3/30/19
EIN 27-4535464
Case Number EO-2014279-000408
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE BELLA VIDA FOUNDATION
Organization’s Mailing Address 1403 CENTINELA AVENUE
City INGLEWOOD
State CA
ZIP 90302-1141
Accounting period End 12
Primary contact name LEAH HARDEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JERRY JOHNSON
PRESIDENT
1407 CENTINELA AVEUE
INGLEWOOD CA 90302-1141

Officer/Director/Trustee Two

JESSICA JOHNSON
SECRETARY
1407 CENTINELA AVE
INGLEWOOD CA 90302-1141

Organization’s website WWW.THEBELLAVIDAFOUNDATION.ORG
Organization’s email INFO.BELLAVIDA2014@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/11/2011
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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