FORM 1023-EZ for DOM INTERNATIONAL USA

Field Data
EIN 86-4000449
Case Number EO-2021148-000607
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DOM INTERNATIONAL USA
Organization’s Mailing Address 5050 QUORUM DR STE 700-501
City DALLAS
State TX
ZIP 75254
Accounting period End 12
Primary contact name ELSIE HOLDBROOK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID OWUSU
DIRECTOR AND PRESIDENT
5050 QUORUM DR STE 700-501
DALLAS TX 75254

Officer/Director/Trustee Two

RITA SEGBAWU
TREASURER
5050 QUORUM DR STE 700-501
DALLAS TX 75254

Officer/Director/Trustee Three

ELSIE HOLDBROOK
SECRETARY
5050 QUORUM DR STE 700-501
DALLAS TX 75254

Officer/Director/Trustee Four

EUNICE OWUSU
DIRECTOR
5050 QUORUM DR STE 700-501
DALLAS TX 75254

Officer/Director/Trustee Five

RUTH BEMA BUABENG
DIRECTOR
5050 QUORUM DR STE 700-501
DALLAS TX 75254

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/17/2021
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q33 - International Relief
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 Yes
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 ELSIE HOLDBROOK
Signature Title SECRETARY
Signature Date 5/26/2021

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