FORM 1023-EZ for BLACKROOT THEATRE COMPANY

Field Data
EIN 83-3290663
Case Number EO-2019137-000297
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACKROOT THEATRE COMPANY
Organization’s Mailing Address 313 E 10TH ST
City BELLE
State WV
ZIP 25015-1712
Accounting period End 12
Primary contact name CATHY DEOBLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CATHY DEOBLER
ARTISTIC & MANAGING DIRECTOR
313 E 10TH ST
BELLE WV 25015-1712

Officer/Director/Trustee Two

DANIEL PEARLSON
EXECUTIVE DIRECTOR
7 BEACON HILL
CHARLESTON WV 25311

Organization’s website BLACKROOTTHEATRE.ORG
Organization’s email BLACKROOTTHEATRE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/25/19
Organization Incorporation State WV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A61 - Performing Arts Centers
Organization’s purpose Charitable: Yes
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 CATHY DEOBLER
Signature Title ARTISTIC & MANAGING DIRECTOR
Signature Date 5/15/19

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