FORM 1023-EZ for GOOD SAMARITAN ORPHANAGE INC

Field Data
EIN 45-5501577
Case Number EO-2017230-000111
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GOOD SAMARITAN ORPHANAGE INC
Organization’s Mailing Address 11351 NW 30TH PL
City SUNRISE
State FL
ZIP 33323
Accounting period End 12
Primary contact name LISTA JOSEPH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LISTA JOSEPH
PRESIDENT
11351 NW 30TH PL
SUNRISE FL 33323

Officer/Director/Trustee Two

NARDO DORSIN
TREASURER
11351 NW 30TH PL
SUNRISE FL 33323

Officer/Director/Trustee Three

FELICIA JOSEPH
SECRETARY
11351 NW 30TH PL
SUNRISE FL 33323

Organization’s website
Organization’s email NOVAVENDETTA@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/29/2012
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other 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 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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