FORM 1023-EZ for BLOSSOM FLOWER BLOSSOM

Field Data
EIN 83-3760490
Case Number EO-2019094-000295
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLOSSOM FLOWER BLOSSOM
Organization’s Mailing Address 211 PROVIDENCE ROAD
City CHESAPEAKE
State VA
ZIP 23325
Accounting period End 12
Primary contact name SUMALEE BANDY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUMALEE BANDY
PRINCIPAL OFFICER
4016 CANDLEWOOD DR
HAMPTON VA 23666

Officer/Director/Trustee Two

TI JUANA GHOLSON
OFFICER
5252 OLDE TOWNE RD
WILLIAMSBURG VA 23188

Officer/Director/Trustee Three

JUSTIN WOFFORD
OFFICER
12728 SANDPEBBLE CIRCLE APT 4
NEWPORT NEWS VA 23606

Officer/Director/Trustee Four

IRIS GUNTER
OFFICER
2217 OAK DR
TARBORO NC 27887

Officer/Director/Trustee Five

AHJA MCCULLOUGH
OFFICER
4105 HAZELWOOD DR
HAMPTON VA 23666

Organization’s website WWW.BLOSSOMFLOWERBLOSSOM.ORG
Organization’s email INFO@BLOSSOMFLOWERBLOSSOM.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/25/19
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 SUMALEE BANDY
Signature Title PRINCIPAL OFFICER
Signature Date 4/2/19

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