FORM 1023-EZ for AZ ONE ANNIE C FOUNDATION

Field Data
EIN 81-4235550
Case Number EO-2019151-000373
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AZ ONE ANNIE C FOUNDATION
Organization’s Mailing Address 720 HARRELL SIDING RD
City KELFORD
State NC
ZIP 27847
Accounting period End 12
Primary contact name SHARMAINE LEE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSEPH RAMPERSAD
BOARD CHAIRMAN
244 OLD US HIGHWAY 13
AHOSKIE NC 27910

Officer/Director/Trustee Two

JENNIFER BROWN
BOARD SECRETARY
P O BOX 300
PINETOPS NC 27864

Officer/Director/Trustee Three

SHARMAINE LEE
FOUNDATION COORDINATOR
720 HARRELL SIDING RD
KELFORD NC 27847

Officer/Director/Trustee Four

ERICA HERRING
BOARD MEMBER
129 DAILY ROAD
AHOSKIE NC 27910

Officer/Director/Trustee Five

DEXTER HAYES
BOARD VICE-CHAIRMAN
713 MENOLA ST JOHN ROAD
AHOSKIE NC 27910

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/31/16
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S12 - Fund Raising and/or Fund Distribution
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 Yes
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 Yes
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SHARMAINE LEE
Signature Title FOUNDATION COORDINATOR
Signature Date 5/29/19

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