FORM 1023-EZ for BLUE COLLABORATIVE

Field Data
EIN 83-0781689
Case Number EO-2018158-000302
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLUE COLLABORATIVE
Organization’s Mailing Address 6338 SAHALEE COURT
City CLINTON
State WA
ZIP 98236-9125
Accounting period End 12
Primary contact name ROB VERCHICK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TY MOLBAK
ARTISTIC DIRECTOR, DIRECTOR
2532 JEFFERSON AVE
NEW ORLEANS LA 70115

Officer/Director/Trustee Two

RACHEL KAUFMAN
DIRECTOR
236 W 135TH STREET
NEW YORK NY 10030

Officer/Director/Trustee Three

ROBERT VERCHICK
DIRECTOR
2532 JEFFERSON AVE
NEW ORLEANS LA 70115

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/17/18
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A20 - Arts, Cultural Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 ROBERT VERCHICK
Signature Title DIRECTOR
Signature Date 6/5/18

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