FORM 1023-EZ for SUPPORTED EMPLOYMENT AND INDEPENDENT SERVICES INC

Field Data
EIN 83-2433402
Case Number EO-2019105-000466
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SUPPORTED EMPLOYMENT AND INDEPENDENT SERVICES INC
Organization’s Mailing Address 5209 NW 18TH STREET UNIT 4
City LAUDERHILL
State FL
ZIP 33313
Accounting period End 10
Primary contact name PRISCILLA HAYNES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PRISCILLA HAYNES
PRESIDENT
5209 NW 18TH STREET UNIT 4
LAUDERHILL FL 33313

Officer/Director/Trustee Two

SONIA FORBES
VICE PRESIDENT
740 NE 41ST STREET UNIT 304
POMPANO BEACH FL 33064

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/10/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 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 PRISCILLA HAYNES
Signature Title PRESIDENT
Signature Date 4/12/19

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