FORM 1023-EZ for BLAISE BLACK FOUNDATION INC

Field Data
EIN 26-0576181
Case Number EO-2015021-000203
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLAISE BLACK FOUNDATION INC
Organization’s Mailing Address 1818 W SPANISH BAY DRIVE
City EAGLE
State ID
ZIP 83616
Accounting period End 12
Primary contact name DOUGLAS E BLACK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MIKAL SMITH
DIRECTOR
1818 W SPANISH BAY DRIVE
EAGLE ID 83616

Officer/Director/Trustee Two

ORLA KNIGHT
DIRECTOR
PO BOX 47
HAMMETT ID 83627-0047

Officer/Director/Trustee Three

BRAD CARPENTER
DIRECTOR
12411 MOSS LANE
NAMPA ID 83651-8106

Officer/Director/Trustee Four

ROBERT E BLACK
DIRECTOR
35050 HWY 89
WICKENBURG AZ 85390

Officer/Director/Trustee Five

DOUGLAS E BLACK
DIRECTOR
605 E RIVER QUARRY COURT
EAGLE ID 83616-6351

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/24/2007
Organization Incorporation State ID
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 Yes
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
Signature Title
Signature Date

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