FORM 1023-EZ for SOUTH SUDAN EDUCATION MISSION

Field Data
EIN 46-4103053
Case Number EO-2016048-000270
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTH SUDAN EDUCATION MISSION
Organization’s Mailing Address 3525 WINDSOR AVE APT 107
City DUBUQUE
State IA
ZIP 52001
Accounting period End 12
Primary contact name SHIRLEY VANDUSER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PAUL BOTH
DIRECTOR
12155 PARTRIDGE ST NW
COON RAPIDS MN 55448

Officer/Director/Trustee Two

DANA PERREARD
CO-DIRECTOR
5341 SHERRILL RD
SHERRILL IA 52073

Officer/Director/Trustee Three

SHIRLEY VANDUSER
TREASURER
3525 WINDSOR AVE APT 107
DUBUQUE IA 52001

Officer/Director/Trustee Four

BEVERLY VANDERZYL
BOARD MEMBER
35 TRUMAN DR
EAST DUBUQUE IL 61025

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/7/2013
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A12 - Fund Raising and/or Fund Distribution
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 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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