FORM 1023-EZ for SUPREME SKILLZ DEVELOPMENT ASSOCIATION

Field Data
EIN 45-2212328
Case Number EO-2021147-000294
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SUPREME SKILLZ DEVELOPMENT ASSOCIATION
Organization’s Mailing Address 19318 PIERSON
City DETROIT
State MI
ZIP 48219
Accounting period End 12
Primary contact name SHANNON SULLIVAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRIAN AUTRY
PRESIDENT CEO
19318 PIERSON
DETROIT MI 48219

Officer/Director/Trustee Two

SHANNON SULLIVAN
COO
17234 WOODBINE
DETROIT MI 48219

Officer/Director/Trustee Three

CHERISE DONELSON
CFO
16827 FENMORE
DETROIT MI 48219

Organization’s website
Organization’s email SUPREMESKILLZDA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/23/2011
Organization Incorporation State MI
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: 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name BRIAN AUTRY
Signature Title PRESIDENT CEO
Signature Date 5/25/2021

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