FORM 1023-EZ for PAUL SIMON JR IMPACT FOUNDATION

Field Data
EIN 81-4715295
Case Number EO-2017017-000326
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PAUL SIMON JR IMPACT FOUNDATION
Organization’s Mailing Address 345 MARSHALL AVE LOWER LEVEL
City WEBSTER GROVES
State MO
ZIP 63119
Accounting period End 12
Primary contact name JIM SIMON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PAUL SIMON III
PRESIDENT
1140 CHAVANIAC DRIVE
BALLWIN MO 63119

Officer/Director/Trustee Two

JIM SIMON
VICE PRESIDENT
345 MARSHALL AVE
WEBSTER MO 63119

Officer/Director/Trustee Three

THOMAS SUNTRUP
DIRECTOR
10340 MANCHESTER RD
KIRKWOOD MO 63122

Officer/Director/Trustee Four

JIM SANSONE
DIRECTOR
120 S CENTRAL AVE
CLAYTON MO 63105

Officer/Director/Trustee Five

JIM HILL
DIRECTOR
190 CARONDELET
CLAYTON MO 63105

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/7/2016
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - 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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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