FORM 1023-EZ for REFUGE PLACE INTERNATIONAL USA

Field Data
EIN 45-1649062
Case Number EO-2020267-000415
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name REFUGE PLACE INTERNATIONAL USA
Organization’s Mailing Address 3424 KEITHSHIRE WAY
City LEXINGTON
State KY
ZIP 40503-4109
Accounting period End 10
Primary contact name JACK WILSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JACK WILSON
DIRECTOR
3424 KEITHSHIRE WAY
LEXINGTON KY 40503-4109

Officer/Director/Trustee Two

MOSOKA FALLAH
PRESIDENT CEO
3424 KEITHSHIRE WAY
LEXINGTON KY 40503-4109

Officer/Director/Trustee Three

NIRMAL RAVI
SECRETARY
4740BRADLEY BLVD
CHEVY CHASE MD 20815

Officer/Director/Trustee Four

VARNEY TAYLOR
TREASURER
1775 EYE ST NW SUITE 1150
WASHINGTON DC 20006

Officer/Director/Trustee Five

JOHN BERESTCK
DIRECTOR
2084 PALOLO AVE
HONOLULU HI 96816

Organization’s website
Organization’s email JACKAWILSON39@WINDSTREAM.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/11/2011
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E11 - Single Organization Support
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 JACK WILSON
Signature Title DIRECTOR
Signature Date 9/21/2020

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