FORM 1023-EZ for SUSQUENITA BLACKHAWK FOUNDATION

Field Data
EIN 85-0833192
Case Number EO-2020135-000187
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SUSQUENITA BLACKHAWK FOUNDATION
Organization’s Mailing Address 1725 SCHOOLHOUSE ROAD
City DUNCANNON
State PA
ZIP 17020-9582
Accounting period End 6
Primary contact name JOHN RUBISCH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN RUBISCH
PRESIDENT
331 FRONT STREET
MARYSVILLE PA 17053-1415

Officer/Director/Trustee Two

STEPHANIE DORMAN
VICE PRESIDENT
48 MILL STREET
DUNCANNON PA 17020-7137

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/2020
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
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 JOHN RUBISCH
Signature Title PRESIDENT
Signature Date 5/12/2020

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