FORM 1023-EZ for INSTITUTE FOR BLACK AND AFRICAN-AMERICAN MENTAL HEALTH INC

Field Data
EIN 82-4698104
Case Number EO-2018107-000853
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name INSTITUTE FOR BLACK AND AFRICAN-AMERICAN MENTAL HEALTH INC
Organization’s Mailing Address 674 SAW MILL BROOK PKWY
City NEWTON
State MA
ZIP 2459
Accounting period End 12
Primary contact name AMETE REDA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AMETE REDA
PRESIDENT
674 SAW MILL BROOK PKWY
NEWTON MA 2459

Officer/Director/Trustee Two

TIGISTY ZERISLASSIE
VICE PRESIDENT
3351 JONES BRIDGE ROAD
CHEVY CHASE MD 20815

Officer/Director/Trustee Three

ROCHELLE JAMES
TREASURER
620 SOUTH ST 1
ROSLINDALE MA 2131

Officer/Director/Trustee Four

RUFUS FAULK
BOARD MEMBER
120 HUMBOLDT AVE
BOSTON MA 2121

Officer/Director/Trustee Five

SHAHI SMART
SECRETARY
512 BORDER ST APT D
EAST BOSTON MA 2128

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/8/18
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
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 AMETE REDA
Signature Title PRESIDENT
Signature Date 3/29/18

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