FORM 1023-EZ for FIVE STAR ELEVATION ENTERPRISE FOUNDATION INC

Field Data
EIN 84-2408249
Case Number EO-2019212-000150
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FIVE STAR ELEVATION ENTERPRISE FOUNDATION INC
Organization’s Mailing Address 3703 JUNCTION BLVD
City RALEIGH
State NC
ZIP 27603-5263
Accounting period End 12
Primary contact name JOHN O OTI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN O OTI
PRESIDENT/FOUNDER
2312 LAUREL FALLS LN
RALEIGH NC 27603-5872

Officer/Director/Trustee Two

GRACE E OTI
VICE PRESIDENT/TREASURER
2312 LAUREL FALLS LN
RALEIGH NC 27603-5872

Officer/Director/Trustee Three

OBIAGELI NWANKWO
SECRETARY
11711-108 MEZZANINE DR
RALEIGH NC 27614-9594

Officer/Director/Trustee Four

PETER OKE-BELLO
FINANCIAL SECRETARY/CPA
3509 LOWNWOOD WAY
RALEIGH NC 27616-8661

Officer/Director/Trustee Five

ALEX MOSES
DIRECTOR
1177 PARK AVE STE 5 PMB 150
ORANGE PARK FL 32073-4150

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/11/19
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P73 - Group Home (Long Term)
Organization’s purpose Charitable: Yes
Religious: Yes
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 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 JOHN O OTI
Signature Title PRESIDENT/FOUNDER
Signature Date 7/29/19

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