FORM 1023-EZ for AFRICAN AMERICAN MENTAL HEALTH INITIATIVE

Field Data
EIN 47-4353349
Case Number EO-2015253-000359
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AFRICAN AMERICAN MENTAL HEALTH INITIATIVE
Organization’s Mailing Address 4210 EMERALD BAY DR
City JACKSONVILLE
State FL
ZIP 32277
Accounting period End 7
Primary contact name WYVETTA MARLOW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WYVETTA MARLOW
PRESIDENT
4210 EMERALD BAY DR
JACKSONVILLE FL 32277

Officer/Director/Trustee Two

BRUCE MATTHEWS
TREASURER
2884 GOLDEN POND BLVD
ORANGE PARK FL 32073

Officer/Director/Trustee Three

JIMMY MARLOW
VICE PRESIDENT
4210 EMERALD BAY DR
JACKSONVILLE FL 32277

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/14/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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 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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