FORM 1023-EZ for THE DEEBO SAMUEL FOUNDATION

Field Data
EIN 84-3978497
Case Number EO-2019353-000199
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE DEEBO SAMUEL FOUNDATION
Organization’s Mailing Address 605 NETTIE DRIVE
City INMAN
State SC
ZIP 29349
Accounting period End 12
Primary contact name LUKE A FEDLAM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TYSHUN SAMUEL
DIRECTOR
603 NETTIE DR
INMAN SC 29349

Officer/Director/Trustee Two

PRECIOUS MARTIN
DIRECTOR
603 NETTIE DR
INMAN SC 29349

Officer/Director/Trustee Three

GALEN SAMUEL
DIRECTOR
603 NETTIE DR
INMAN SC 29349

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/5/2019
Organization Incorporation State SC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 PRECIOUS MARTIN
Signature Title DIRECTOR
Signature Date 12/17/2019

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