FORM 1023-EZ for UNITED SURVIVORS HOUSING FOUNDATION

Field Data
EIN 47-1742363
Case Number EO-2014342-000412
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name UNITED SURVIVORS HOUSING FOUNDATION
Organization’s Mailing Address 8742 HAYDEN WAY
City CONCORD
State NC
ZIP 28025-8521
Accounting period End 12
Primary contact name JEREMIAH FENNESSY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JEREMIAH FENNESSY
EXECUTIVE DIRECTOR
8742 HAYDEN WAY
CONCORD NC 28025-8521

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/3/2014
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P43 - Family Violence Shelters, Services
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 Yes
Donation of funds Yes
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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