FORM 1023-EZ for SOUTHLAND REGIONAL MAYORAL BLACK CAUCUS INC

Field Data
EIN 90-0940305
Case Number EO-2018250-000315
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SOUTHLAND REGIONAL MAYORAL BLACK CAUCUS INC
Organization’s Mailing Address 15652 HOMAN AVE
City MARKHAM
State IL
ZIP 60428
Accounting period End 12
Primary contact name VICKI FORMAN-BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VERNARD ALSBERRY JR
PRESIDENT, DIRECTOR
3321 TULIP DRIVE
HAZEL CREST IL 60429

Officer/Director/Trustee Two

TYRONE WARD
VICE PRESIDENT
3327 W 137TH STREET
ROBBINS IL 60472

Officer/Director/Trustee Three

TERRY WELLS
SECRETARY
633 EAST 151ST STREET
PHOENIX IL 60426

Officer/Director/Trustee Four

ROBERT POLK
TREASURER
14450 S MANISTEE AVENUE
BURNHAM IL 60633

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/31/13
Organization Incorporation State IL
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 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 VERNARD ALSBERRY JR
Signature Title PRESIDENT
Signature Date 9/5/18

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