FORM 1023-EZ for LIFELINE SHOEBOX INC

Field Data
EIN 81-4368082
Case Number EO-2020219-000300
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIFELINE SHOEBOX INC
Organization’s Mailing Address 300 DRAPER CT
City WINSTON SALEM
State NC
ZIP 27105
Accounting period End 12
Primary contact name WANDA REID
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WANDA REID
EXECUTIVE DIRECTOR
300 DRAPER CT
WINSTON SALEM NC 27105

Officer/Director/Trustee Two

DERRICK HOLLAND
PRESIDENT
867 CRAWFORD ST
WINSTON SALEM NC 27101

Officer/Director/Trustee Three

LUCIANA PHILYAW
VICE PRESIDENT
31 SOUTH HEATHROW DR
ROME GA 30165

Officer/Director/Trustee Four

KENNETH REID
SECRETARY/TREASURER
5308 MCCONNELL DR
KERNERSVILLE NC 27284

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/20/2016
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 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 WANDA REID
Signature Title EXECUTIVE DIRECTOR
Signature Date 8/4/2020

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