FORM 1023-EZ for BROKEN LEAF TRANSITIONAL HOUSING

Field Data
EIN 80-0850581
Case Number EO-2019035-000088
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BROKEN LEAF TRANSITIONAL HOUSING
Organization’s Mailing Address 1610 BEECH
City TEXARKANA
State AR
ZIP 71854
Accounting period End 12
Primary contact name LYNETTE JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LYNETTE JACKSON
EXECUTIVE DIRECTOR
1610 BEECH STREET
TEXARKANA AR 71854

Officer/Director/Trustee Two

IDA MILLOR
SECRETARY
1610 BEECH STREET
TEXARKANA AR 71854

Officer/Director/Trustee Three

SANDRA LEWIS-BRUCE
TREASURER
3155 FM 559
TEXARKANA TX 75503

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/24/12
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P72 - Half-Way House (Short-Term Residential Care)
Organization’s purpose Charitable: Yes
Religious: Yes
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 LYNETTE JACKSON
Signature Title EXECUTIVE DIRECTOR
Signature Date 1/15/19

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