FORM 1023-EZ for SIMMONS FAMILY FOUNDATION

Field Data
EIN 47-5605864
Case Number EO-2016014-000349
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SIMMONS FAMILY FOUNDATION
Organization’s Mailing Address 12150 E 96TH STREET SUITE 202
City OWASSO
State OK
ZIP 74055-5340
Accounting period End 12
Primary contact name STEPHEN ROTHSCHILD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GREGORY SIMMONS
DIRECTOR
12150 E 96TH STREET SUITE 202
OWASSO OK 74055-5340

Officer/Director/Trustee Two

PATRICIA SIMMONS
DIRECTOR
12150 E 96TH STREET SUITE 202
OWASSO OK 74055-5340

Officer/Director/Trustee Three

W JEFFREY CONKLIN
DIRECTOR
2738 E 51ST STREET SUITE 370
TULSA OK 74105-6231

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/27/2015
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T22 - Private Independent Foundations
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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