FORM 1023-EZ for UTAH BLACK HISTORY MUSEUM

Field Data
EIN 85-4234303
Case Number EO-2021085-000939
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name UTAH BLACK HISTORY MUSEUM
Organization’s Mailing Address 175 EAST 200 NORTH
City LOGAN
State UT
ZIP 84321
Accounting period End 12
Primary contact name ELIZABETH LAMBSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ELIZABETH LAMBSON
DIRECTOR
1220 SOUTH MCCLELLAND STREET
SALT LAKE CITY UT 84105

Officer/Director/Trustee Two

MARIO MATHIS
DIRECTOR
175 EAST 200 NORTH
LOGAN UT 84321

Officer/Director/Trustee Three

ALEXIS SCOTT
DIRECTOR
865 EAST 4800 SOUTH SUITE 221
SALT LAKE CITY UT 84106

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/4/2020
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A54 - History Museums
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 ELIZABETH LAMBSON
Signature Title DIRECTOR
Signature Date 2/5/2021

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