FORM 1023-EZ for DECASSI FOUNDATION

Field Data
EIN 82-3999991
Case Number EO-2019165-000295
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DECASSI FOUNDATION
Organization’s Mailing Address 118 KRAMER COURT
City CARY
State NC
ZIP 27511
Accounting period End 11
Primary contact name JODY JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DELVA DOUGLAS
FOUNDER
118 KRAMER COURT
CARY NC 27511

Officer/Director/Trustee Two

JODY JACKSON
CEO
118 KRAMER COURT
CARY NC 27511

Organization’s website
Organization’s email NPO@DECASSIFOUNDATION.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/17/17
Organization Incorporation State NC
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 Yes
Compensation of Officer director trustee Yes
Donation of funds Yes
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 Yes
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 JODY JACKSON
Signature Title CEO
Signature Date 6/12/19

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