FORM 1023-EZ for HEALING AND SURVIVAL OUTREACH MINISTRIES

Field Data
EIN 56-2639247
Case Number EO-2016095-000487
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEALING AND SURVIVAL OUTREACH MINISTRIES
Organization’s Mailing Address 665 CLAIBORNE AVE
City JACKSON
State MS
ZIP 39209
Accounting period End 12
Primary contact name LATASHA WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LATASHA WILLIAMS
PRESIDENT
665 CLAIBORNE AVE
JACKSON MS 39209

Officer/Director/Trustee Two

TONY CLINCY
TREASURER
1706 RESERVE DRIVE
CLINTON MS 39056

Officer/Director/Trustee Three

EARNESTINE BUTLER
SECRETARY
601 ROAD OF REMEMBERANCE
JACKSON MS 39209

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/19/2007
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B90 - Educational Services and Schools - Other
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 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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