FORM 1023-EZ for SURVIVE AND THRIVE CANCER RECOVERY

Field Data
EIN 84-4254258
Case Number EO-2021109-000677
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SURVIVE AND THRIVE CANCER RECOVERY
Organization’s Mailing Address 3226 KAY BRIDGES PLACE
City STOCKTON
State CA
ZIP 95206
Accounting period End 12
Primary contact name SHANNON GRIFFIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALICIA PERRY
PRESIDENT
3909 SANDPIPIER
MODESTO CA 95356

Officer/Director/Trustee Two

WILLIAM PIERRE IV LAWSON IV
CHIEF FINANCIAL OFFICER
1483 WEST CENTER STREET 107
MANTECA CA 95337

Officer/Director/Trustee Three

SHANNON GRIFFIN
DIRECTOR
3226 KAY BRIDGES PLACE
STOCKTON CA 95206

Officer/Director/Trustee Four

LATINA STARLING
SECRETARY
29011 E PECOS RIVER COURT
SPRING TX 77386

Organization’s website SURVIVEANDTHRIVECR.ORG
Organization’s email THRIVE@SURVIVEANDTHRIVECR.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/9/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, 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 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 SHANNON GRIFFIN
Signature Title DIRECTOR
Signature Date 4/17/2021

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