FORM 1023-EZ for SELF EMPOWERMENT INC

Field Data
EIN 84-2735888
Case Number EO-2019231-000553
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SELF EMPOWERMENT INC
Organization’s Mailing Address 10810 GOLF COURSE TERRACE
City BOWIE
State MD
ZIP 20721
Accounting period End 12
Primary contact name ERNESTO HERBERT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERNESTO HERBERT
PRESIDENT
10810 GOLF COURSE TERRACE
BOWIE MD 20721

Officer/Director/Trustee Two

CHRISTINE HAIDER
TREASURER
10810 GOLF COURSE TERRACE
BOWIE MD 20721

Officer/Director/Trustee Three

SHADI HAIDER
CHAIRPERSON
10810 GOLF COURSE TERRACE
BOWIE MD 20721

Officer/Director/Trustee Four

JANET NYEMAH
OFFICER
1173 OAKS PLACE
STONE MOUNTAIN GA 30083

Officer/Director/Trustee Five

EDWARD DICKSON
OFFICER
10810 GOLF COURSE TERRACE
BOWIE MD 20721

Organization’s website
Organization’s email DWEHSIDI@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/19/19
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q30 - International Development, Relief Services
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 Yes
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 ERNESTO HERBERT
Signature Title PRESIDENT
Signature Date 8/16/19

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