FORM 1023-EZ for AFRICAN AMERICAN HEALTH NETWORK

Field Data
EIN 47-1045318
Case Number EO-2014314-000062
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AFRICAN AMERICAN HEALTH NETWORK
Organization’s Mailing Address 2716 KENDALL AVENUE
City MADISON
State WI
ZIP 53705
Accounting period End 12
Primary contact name EVA VIVIAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

EVA VIVIAN
PRESIDENT
2716 KENDALL AVENU
MADISON WI 53705

Officer/Director/Trustee Two

AARON PERRY
VICE PRESIDENT
143 MARCIE DRIVE
BROOKLYN WI 53521

Officer/Director/Trustee Three

GALE JOHNSON
SECRETARY
6011 COTTONTAIL TRAIL
MADISON WI 53718

Officer/Director/Trustee Four

BETTY BANKS
TREASURER
1606 FORDEM AVENUE APT 16
MADISON WI 53704

Organization’s website AAHNMADISON.ORG
Organization’s email AAHNMADISON@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/17/2014
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S01 - 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 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
Signature Title
Signature Date

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