FORM 1023-EZ for I AM SURVIVOR INC

Field Data
EIN 47-2662990
Case Number EO-2015035-000233
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name I AM SURVIVOR INC
Organization’s Mailing Address 16192 COASTAL HIGHWAY
City LEWES
State DE
ZIP 19958
Accounting period End 12
Primary contact name CATHERINE MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CATHERINE MILLER
CHAIRMAN OF BOARD, ED
16192 COASTAL HIGHWAY
LEWES DE 35674-6904

Officer/Director/Trustee Two

VICKIE STENNETT
DIRECTOR, TREASURER
24 THIRD AVENUE
TISHOMINGO MS 38873-8445

Officer/Director/Trustee Three

JENNIFER ELIASSEN
DIRECTOR, SECRETARY
8590 HIGHWAY 73
EVERGREEN CO 80439-6247

Organization’s website IAMSURVIVOR.COM
Organization’s email ACCOUNTING@IAMSURVIVOR.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/17/2014
Organization Incorporation State DE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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