FORM 1023-EZ for PHS CO 1977 INC

Field Data
EIN 82-2500713
Case Number EO-2017305-000472
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PHS CO 1977 INC
Organization’s Mailing Address 3701 LAKE CATHERINE DR
City HARVEY
State LA
ZIP 70058
Accounting period End 12
Primary contact name RICKEY JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICKEY JACKSON
PRESIDENT
3701 LAKE CATHERINE DR
HARVEY LA 70058

Officer/Director/Trustee Two

RICKEYAH JACKSON
SECRETARY
3701 LAKE CATHERINE DR
HARVEY LA 70058

Officer/Director/Trustee Three

JAMES SMITH
VICE PRESIDENT
1172 WEST 31ST STREET
RIVIERA FL 33404

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/16/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A11 - Single Organization Support
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
Signature Title
Signature Date

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