FORM 1023-EZ for PHI OMICRON ZETA STORKS NEST INC

Field Data
EIN 84-1931017
Case Number EO-2021140-000420
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PHI OMICRON ZETA STORKS NEST INC
Organization’s Mailing Address PO BOX 2253
City COVINGTON
State GA
ZIP 30015
Accounting period End 6
Primary contact name SHAWNA KALEENA JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARILYN BARTON
INCORPORATOR
PO BOX 2253
COVINGTON GA 30015

Officer/Director/Trustee Two

SANDRA BATES
CEO
PO BOX 2253
COVINGTON GA 30015

Officer/Director/Trustee Three

SHAWNA KALEENA JACKSON
CFO
PO BOX 2253
COVINGTON GA 30015

Organization’s website ZPHIBPOZETA.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/30/2019
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
Religious: No
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 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 SANDRA BATES
Signature Title CEO
Signature Date 5/13/2021

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