FORM 1023-EZ for SUCCESSFUL STUDENT ATHLETE INC

Field Data
EIN 47-4080280
Case Number EO-2016120-000127
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SUCCESSFUL STUDENT ATHLETE INC
Organization’s Mailing Address 3403 VILLAGE PARK LANE
City ATLANTA
State GA
ZIP 30331-7951
Accounting period End 1
Primary contact name TABUGBO ANYANSI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TABUGBO ANYANSI
CEO
3403 VILLAGE PARK LANE
ATLANTA GA 30331-7951

Officer/Director/Trustee Two

LOUSIA ANYANSI
CFO
13575 BANCROFT AVENUE APT 306
SAN LEANDRO CA 94578

Officer/Director/Trustee Three

PHILLIP ROGERS
DIRECTOR
1316 EGAN WAY
EAST POINT GA 30344-4947

Officer/Director/Trustee Four

JP JAMES
DIRECTOR
945 E PACES FERRY RD NE STE 2250
ATLANTA GA 30326-2900

Officer/Director/Trustee Five

FRANKLYN SIMMONS
DIRECTOR
1425 ADAMS DRIVE
ATLANTA GA 30311-3621

Organization’s website
Organization’s email SUCCESSFULSTUDENTATHLETE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/2015
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O53 - Youth Development - Business
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 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
Signature Title
Signature Date

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