FORM 1023-EZ for SAMARITAN AMERICANS INC

Field Data
EIN 81-4639482
Case Number EO-2017017-000306
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SAMARITAN AMERICANS INC
Organization’s Mailing Address 284 ARIEL DR
City LEESBURG
State VA
ZIP 20176
Accounting period End 12
Primary contact name JOHN CHAPIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BEN CHAPIN
PRESIDENT
284 ARIEL DR
LEESBURG VA 20176

Officer/Director/Trustee Two

JOHN CHAPIN
TREASURER
284 ARIEL DR
LEESBURG VA 20176

Officer/Director/Trustee Three

SATHIANAN CLARKE
SECRETARY
10803 MCCOMAS CT
KENSINGTON MD 20895

Organization’s website WWW.SAMARITANAMERICANS.ORG
Organization’s email SAMARITAN@SAMARITANAMERICANS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/22/2016
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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 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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