FORM 1023-EZ for DELTA SURVIVORS INCORPORATION

Field Data
EIN 37-1847424
Case Number EO-2020062-000221
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DELTA SURVIVORS INCORPORATION
Organization’s Mailing Address 348 PHILLIPS RD
City LEXA
State AR
ZIP 72355
Accounting period End 12
Primary contact name THOMAS JACKSON II
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PAULA OLIVER
DIRECTOR
1039 PARK
HELENA AR 72342

Officer/Director/Trustee Two

JOSEPHINE JACKSON
DIRECTOR
348 PHILLIPS ROAD
LEXA AR 72355

Officer/Director/Trustee Three

THOMAS JACKSON II
DIRECTOR
4656HWY 242W
HELENA AR 72342

Organization’s website
Organization’s email DELTASURVIVORSINC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/17/2017
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G32 - Breast Cancer
Organization’s purpose Charitable: Yes
Religious: No
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 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 THOMAS JACKSON II
Signature Title DIRECTOR
Signature Date 2/27/2020

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