FORM 1023-EZ for SUPER SELF-CARE

Field Data
EIN 83-4660194
Case Number EO-2019128-000303
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SUPER SELF-CARE
Organization’s Mailing Address 2787 NORTH HOUSTON STREET
City DALLAS
State TX
ZIP 75219
Accounting period End 12
Primary contact name DEYA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEYA SMITH-TAYLOR
EXECUTIVE DIRECTOR
2787 NORTH HOUSTON STREET 4032
DALLAS TX 75219

Officer/Director/Trustee Two

VERLIN TAYLOR
CFO
PO BOX 0496
CEDAR HILL TX 75106

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/6/19
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B80 - Student Services, Organizations of Students
Organization’s purpose Charitable: No
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 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 DEYA SMITH-TAYLOR
Signature Title EXECUTIVE DIRECTOR
Signature Date 5/6/19

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