FORM 1023-EZ for AFRICAN AMERICAN SURVIVOR SERVICES

Field Data
EIN 85-2081596
Case Number EO-2020244-000039
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AFRICAN AMERICAN SURVIVOR SERVICES
Organization’s Mailing Address 192 LARPENTEUR AVE E
City SAINT PAUL
State MN
ZIP 55117
Accounting period End 12
Primary contact name JOSEPH BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

IVAN NELSON
CHAIRMAN OF THE BOARD
653 HUMBOLDT AVE
SAINT PAUL MN 55107

Officer/Director/Trustee Two

JOSEPH BROWN
VICE CHAIRMAN
192 LARPENTEUR AVE E
SAINT PAUL MN 55117

Officer/Director/Trustee Three

KENNETH B JACKSON
TREASURER
9333 NASBITT RD
BLOOMINGTON MN 55437

Officer/Director/Trustee Four

KELLIE KRENIK
SECRETARY
192 LARPENTEUR AVE E
SAINT PAUL MN 55117

Officer/Director/Trustee Five

THADIOUS WALKER
BOARD MEMBER
653 HUMBOLDT AVE
SAINT PAUL MN 55107

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/27/2020
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
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 IVAN NELSON
Signature Title CHAIRMAN OF THE BOARD
Signature Date 8/29/2020

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