FORM 1023-EZ for PERSEVERE TO SHINE FOUNDATION

Field Data
EIN 85-1889603
Case Number EO-2020247-000017
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PERSEVERE TO SHINE FOUNDATION
Organization’s Mailing Address 3801 W 52ND PLACE
City TULSA
State OK
ZIP 74107
Accounting period End 12
Primary contact name BETH PETERSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BETH PETERSEN
DIRECTOR
3801 W 52ND PL
TULSA OK 74107

Officer/Director/Trustee Two

JENNIE LILLARD
DIRECTOR
610 E TIGER
WETUMKA OK 74883

Officer/Director/Trustee Three

KATIE MARCHAND
OFFICER
610 E TIGER
WETUMKA OK 74883

Officer/Director/Trustee Four

CHRIS STEPHENS
OFFICER
2608 W KENOSHA ST SUITE 311
BROKEN ARROW OK 74012

Officer/Director/Trustee Five

ANDREA SCRAPER
OFFICER
213 S DIXON AVE
SHAWNEE OK 74801

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/10/2020
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
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 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 No
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name BETH PETERSEN
Signature Title DIRECTOR
Signature Date 9/1/2020

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