FORM 1023-EZ for SURVIVOR DIVERS INC

Field Data
EIN 82-1039310
Case Number EO-2021273-000426
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SURVIVOR DIVERS INC
Organization’s Mailing Address 9101 ALTA DRIVE UNIT 306
City LAS VEGAS
State NV
ZIP 89145
Accounting period End 12
Primary contact name KEVIN MCCARTHY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEVIN MCCARTHY JR
PRESIDENT
9101 ALTA DRIVE UNIT 306
LAS VEGAS NV 89145

Officer/Director/Trustee Two

KEVIN MCCARTHY
DIRECTOR
9101 ALTA DRIVE UNIT 306
LAS VEGAS NV 89145

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/27/2017
Organization Incorporation State NV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name KEVIN MCCARTHY
Signature Title DIRECTOR
Signature Date 9/29/2021
EIN 82-1039310
Case Number EO-2017096-000332
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SURVIVOR DIVERS INC
Organization’s Mailing Address 9101 ALTA DRIVE UNIT 306
City LAS VEGAS
State NV
ZIP 89145
Accounting period End 12
Primary contact name KEVIN MCCARTHY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEVIN MCCARTHY JR
EXECUTIVE DIRECTOR
9101 ALTA DRIVE UNIT 306
LAS VEGAS NV 89145

Officer/Director/Trustee Two

PATRICK SCOTT
DIRECTOR
26 WOODS GROVE
WESTPORT CT 06880

Officer/Director/Trustee Three

GREG JACOBS
DIRECTOR
1011 FIRST ST SE UNIT 812
WASHINGTON DC 20003

Officer/Director/Trustee Four

KEVIN MCCARTHY
TREASURER
9101 ALTA DRIVE UNIT 306
LAS VEGAS NV 89145

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/27/2017
Organization Incorporation State NV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N67 - Swimming, Water Recreation
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 Yes
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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