FORM 1023-EZ for PANAFRICAN INSTITUTE FOR SOCIAL INNOVATION

Field Data
EIN 82-1771634
Case Number EO-2017195-000293
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PANAFRICAN INSTITUTE FOR SOCIAL INNOVATION
Organization’s Mailing Address 5312 OHIO STREET
City SOUTH CHARLESTON
State WV
ZIP 25309
Accounting period End 12
Primary contact name PENNIE ROUECHE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREW CICCARELLO
PRESIDENT DIRECTOR
5312 OHIO STREET
SOUTH CHARLESTON WV 25309

Officer/Director/Trustee Two

DEREK ELLIOTT
VICE-PRESIDENT
9 BOXBERRY LANE
WEST YARMOUTH MA 02673

Officer/Director/Trustee Three

GERALD REIMER
BOARD MEMBER
2000 WEST UNIVERSITY STREET
SILOAM SPRINGS AK 72761

Officer/Director/Trustee Four

PENNIE ROUECHE
SECRETARY-TREASURER
5312 OHIO STREET
SOUTH CHARLESTON WV 25309

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/2017
Organization Incorporation State WV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q32 - International Economic Development
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 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
Signature Title
Signature Date

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