FORM 1023-EZ for POSITIVE SELF-AWARENESS ACADEMY OFVIRGINIA

Field Data
EIN 46-1961116
Case Number EO-2018273-000063
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POSITIVE SELF-AWARENESS ACADEMY OFVIRGINIA
Organization’s Mailing Address 8501 BROOK RD STE A
City GLEN ALLEN
State VA
ZIP 23060
Accounting period End 12
Primary contact name FRANK RUSTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FRANK RUSTIN
PRESIDENT
8613 ACKLEY AVE
HENRICO VA 23228

Officer/Director/Trustee Two

ERIC ASARE
TREASURER
8727 SHRADER RD
HENRICO VA 23228

Officer/Director/Trustee Three

ROBERT GENTRY
SECRETARY
2109 BREMO RD
RICHMOND VA 23230

Officer/Director/Trustee Four

KEITH SCOTT
DIRECTOR
6851 WEST CARNATION ST
RICHMOND VA 23225

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/23/07
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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 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 FRANK RUSTIN
Signature Title PRESIDENT
Signature Date 9/26/18
EIN 46-1961116
Case Number EO-2018273-000063
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POSITIVE SELF-AWARENESS ACADEMY OF VIRGINIA
Organization’s Mailing Address 8501 BROOK RD STE A
City GLEN ALLEN
State VA
ZIP 23060
Accounting period End 12
Primary contact name FRANK RUSTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FRANK RUSTIN
PRESIDENT
8613 ACKLEY AVE
HENRICO VA 23228

Officer/Director/Trustee Two

ERIC ASARE
TREASURER
8727 SHRADER RD
HENRICO VA 23228

Officer/Director/Trustee Three

ROBERT GENTRY
SECRETARY
2109 BREMO RD
RICHMOND VA 23230

Officer/Director/Trustee Four

KEITH SCOTT
DIRECTOR
6851 WEST CARNATION ST
RICHMOND VA 23225

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/23/07
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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 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 FRANK RUSTIN
Signature Title PRESIDENT
Signature Date 9/26/18

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