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TEN LIVES CLUB, INC.

Company Details

Name: TEN LIVES CLUB, INC.
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 03 Jan 2001 (24 years ago)
Entity Number: 2589595
ZIP code: 14075
County: Erie
Place of Formation: New York
Address: 7789 BACK CREEK RD., HAMBURG, NY, United States, 14075

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TEN LIVES CLUB INC 401(K) PROFIT SHARING PLAN & TRUST 2023 161611221 2024-07-22 TEN LIVES CLUB INC 45
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Three-digit plan number (PN) 001
Effective date of plan 2022-01-01
Business code 541990
Sponsor’s telephone number 7166465577
Plan sponsor’s address 3741 LAKE SHORE RD, BLASDELL, NY, 14219

Signature of

Role Plan administrator
Date 2024-07-22
Name of individual signing EDWARD ROJAS
TEN LIVES CLUB INC 401(K) PROFIT SHARING PLAN & TRUST 2022 161611221 2023-04-19 TEN LIVES CLUB INC 37
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Three-digit plan number (PN) 001
Effective date of plan 2022-01-01
Business code 541990
Sponsor’s telephone number 7166465577
Plan sponsor’s address 3741 LAKE SHORE RD, BLASDELL, NY, 14219

Signature of

Role Plan administrator
Date 2023-04-19
Name of individual signing EDWARD ROJAS

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 7789 BACK CREEK RD., HAMBURG, NY, United States, 14075

Filings

Filing Number Date Filed Type Effective Date
010103000439 2001-01-03 CERTIFICATE OF INCORPORATION 2001-01-03

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
342357290 0213600 2017-05-30 3741 LAKE SHORE ROAD, BLASDELL, NY, 14219
Inspection Type Complaint
Scope Partial
Safety/Health Health
Close Conference 2017-05-30
Case Closed 2018-08-15

Related Activity

Type Complaint
Activity Nr 1218379
Health Yes

Violation Items

Citation ID 01001A
Citaton Type Serious
Standard Cited 19100133 A01
Issuance Date 2017-09-14
Abatement Due Date 2017-10-05
Current Penalty 1325.0
Initial Penalty 2716.0
Final Order 2017-10-10
Nr Instances 1
Nr Exposed 1
Gravity 5
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.133(a)(1): The employer did not ensure that each affected employee uses appropriate eye or face protection when exposed to eye or face hazards from flying particles, molten metal, liquid chemicals, acids or caustic liquids, chemical gases or vapors, or potentially injurious light radiation: (a) On or about 5/30/17, an employee pours Chlorox Outdoor Bleach into a 24 ounce spray bottle. The employee's eyes were exposed to liquid splashes of Chlorox Outdoor Bleach, a corrosive liquid with a pH of about 12.9, during pouring. The employer did not ensure that the employee was wearing appropriate chemical splash goggles. ABATEMENT CERTIFICATION REQUIRED
Citation ID 01001B
Citaton Type Serious
Standard Cited 19100151 C
Issuance Date 2017-09-14
Abatement Due Date 2017-10-05
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2017-10-10
Nr Instances 1
Nr Exposed 1
Gravity 5
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.151(c): Where employees were exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body were not provided within the work area for immediate emergency use: (a) On or about 5/30/17, an employee pours Chlorox Outdoor Bleach into a 24-ounce spray bottle. The employee's eyes were exposed to liquid splashes of Chlorox Outdoor Bleach, a corrosive liquid with a pH approximately 12.9, during pouring. Suitable facilities for quick drenching or flushing of the eyes and body were not provided within the work area for immediate emergency use. ABATEMENT CERTIFICATION REQUIRED
Citation ID 01002A
Citaton Type Serious
Standard Cited 19101200 E01
Issuance Date 2017-09-14
Abatement Due Date 2017-10-16
Current Penalty 1325.0
Initial Penalty 1630.0
Final Order 2017-10-10
Nr Instances 1
Nr Exposed 7
Gravity 1
FTA Current Penalty 0.0
Citation text line 1910.1200(e)(1): The employer did not develop, implement, and/or maintain at the workplace a written hazard communication program which describes how the criteria specified in 29 CFR 1910.1200(f), (g), and (h) will be met: a) Veterinary ward - On or about 5/30/17, the employer did not develop, implement, and/or maintain at the workplace a written hazard communication program. Employees use hazardous chemicals such as, but not limited to, isoflurane and chlorhexidine 2 percent which contains 2 propanol and D-gluconic acid, compound with N,N"-bis(4-chlorophenyl)-3,12-diimino-2,4,11,13- tetraazatetradecanediamidine (2:1). a) A written program should include descriptions of how the criteria for: 1. Labeling and other forms of warning; 2. Material Safety Data Sheets AND 3. Employee information and training will be met. Additionally, a list of hazardous chemicals known to be present in the workplace must be compiled. Methods used to inform employees of the hazards associated with non-routine tasks and the informing of contractors of workplace hazard must also be addressed. The written program must be made available upon request. ABATEMENT CERTIFICATION REQUIRED
Citation ID 01002B
Citaton Type Serious
Standard Cited 19101200 H01
Issuance Date 2017-09-14
Abatement Due Date 2017-10-16
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2017-10-10
Nr Instances 1
Nr Exposed 7
Gravity 1
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.1200(h)(1): Employees were not provided effective information and training on hazardous chemicals in their work area at the time of their initial assignment and whenever a new hazard that the employees had not been previously trained about was introduced into their work area: a) Veterinary ward - On or about 5/30/17, employees were not provided with effective information on hazardous chemicals in their work area. Hazardous chemicals used included , but were not limited to, isoflurane and chlorhexidine 2 percent which contains 2 propanol and D-gluconic acid, compound with N,N"-bis(4-chlorophenyl)-3,12-diimino-2,4,11,13- tetraazatetradecanediamidine (2:1). Employees shall be informed of: 1. The requirements of this section: 2. Any operations where hazardous chemicals are present; AND 3. The location and availability of the written Hazard Communication Program, list(s) of hazardous chemicals and Safety Data Sheets. Employee training shall include at least: 1. Methods and observations that may be used to detect the presence or release of a hazardous chemical in the work area. 2. The physical and health hazards of the chemicals in the work area. 3. The measures employees can take to protect themselves such as specific procedures, appropriate work practices, emergency procedures and personal protective equipment to be used. 4. The details of the employers Hazard Communication Program including an explanation of labeling systems, Safety Data Sheets and how employees can obtain and use the appropriate hazard information. ABATEMENT CERTIFICATION REQUIRED
Citation ID 01002C
Citaton Type Serious
Standard Cited 19101200 H03 IV
Issuance Date 2017-09-14
Abatement Due Date 2017-10-16
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2017-10-10
Nr Instances 1
Nr Exposed 7
Gravity 1
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.1200(h)(3)(iv): Employee training did not include the details of the hazard communication program developed by the employer, including an explanation of the labeling system and the safety data sheet, and how employees can obtain and use the appropriate hazard information: a) Veterinary ward - On or about 5/30/17, employee training did not include the details of the hazard communication system including an explanation of the labeling system and the safety data sheet, and how employees can obtain and use the appropriate hazard information. Hazardous chemicals used included, but were not limited to, isoflurane and chlorhexidine 2 percent which contains 2 propanol and D-gluconic acid, compound with N,N"-bis(4-chlorophenyl)-3,12-diimino-2,4,11,13- tetraazatetradecanediamidine (2:1). ABATEMENT CERTIFICATION REQUIRED

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
16-1611221 Corporation Unconditional Exemption 3741 LAKE SHORE RD, NORTH BOSTON, NY, 14110-0000 2003-08
In Care of Name % MARIE EDWARDS
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Organization to Prevent Cruelty to Animals, Real Estate Board, Organization Like Those on Three Preceding Lines
Deductibility Contributions are deductible.
Foundation Organization that receives a substantial part of its support from a governmental unit or the general public 170(b)(1)(A)(vi)
Tax Period 2023-12
Asset 500,000 to 999,999
Income 1,000,000 to 4,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 682459
Income Amount 1691021
Form 990 Revenue Amount 1636355
National Taxonomy of Exempt Entities Animal-Related: Animal Protection and Welfare
Sort Name -

Publication 78 Data

Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)

Organization Name TEN LIVES CLUB INC
EIN 16-1611221
Tax Period 202212
Filing Type E
Return Type 990
File View File
Organization Name TEN LIVES CLUB INC
EIN 16-1611221
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name TEN LIVES CLUB INC
EIN 16-1611221
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name TEN LIVES CLUB INC
EIN 16-1611221
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name TEN LIVES CLUB INC
EIN 16-1611221
Tax Period 201912
Filing Type P
Return Type 990
File View File
Organization Name TEN LIVES CLUB INC
EIN 16-1611221
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name TEN LIVES CLUB INC
EIN 16-1611221
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name TEN LIVES CLUB INC
EIN 16-1611221
Tax Period 201612
Filing Type E
Return Type 990
File View File
Organization Name TEN LIVES CLUB INC
EIN 16-1611221
Tax Period 201512
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
3586747102 2020-04-11 0296 PPP PO Box 253, North Boston, NY, 14110-0253
Loan Status Date 2021-04-17
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 64800
Loan Approval Amount (current) 64800
Undisbursed Amount 0
Franchise Name -
Lender Location ID 46027
Servicing Lender Name Evans Bank, National Association
Servicing Lender Address 8599 Erie Rd, ANGOLA, NY, 14006
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address North Boston, ERIE, NY, 14110-0253
Project Congressional District NY-23
Number of Employees 16
NAICS code 812910
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 46027
Originating Lender Name Evans Bank, National Association
Originating Lender Address ANGOLA, NY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 65401.84
Forgiveness Paid Date 2021-03-24

Date of last update: 30 Mar 2025

Sources: New York Secretary of State