FORM 1023-EZ for SURVIVED INC

Field Data
EIN 82-1599231
Case Number EO-2018130-000112
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SURVIVED INC
Organization’s Mailing Address 1100 W NORTHWEST HWY SUITE 201
City MOUNT PROSPECT
State IL
ZIP 60056
Accounting period End 12
Primary contact name CHARLES T JONES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHARLES JONES
DIRECTOR
1100 W NORTHWEST HWY STE 201
MOUNT PROSPECT IL 60056

Officer/Director/Trustee Two

RYAN BERTRAM
DIRECTOR
849 N FRANKLIN UNIT 1104
CHICAGO IL 60601

Officer/Director/Trustee Three

DAVID PICKETT
DIRECTOR
319 PEACHTREE AVENUE
ATLANTA GA 30305

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/19/17
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - 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 CHARLES JONES
Signature Title DIRECTOR
Signature Date 5/6/18

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