FORM 1023-EZ for BLACK EXCELLENCE ACADEMY

Field Data
EIN 85-3990172
Case Number EO-2021019-000056
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK EXCELLENCE ACADEMY
Organization’s Mailing Address 2020 N BAYSHORE DRIVE SUITE 3904
City MIAMI
State FL
ZIP 33137
Accounting period End 12
Primary contact name ANDREW WILLIAMS ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DERRICK BROWN
CEO
2020 N BAYSHORE DRIVE SUITE 3904
MIAMI FL 33137

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/3/2020
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code J20 - Employment Procurement Assistance, Job Training
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 No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DERRICK BROWN
Signature Title CEO
Signature Date 11/20/2020

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