FORM 1023-EZ for BLACKOUT YOUTH SPORTS INC

Field Data
EIN 83-0669123
Case Number EO-2018164-000164
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACKOUT YOUTH SPORTS INC
Organization’s Mailing Address 20103 NESTOR AVENUE
City CARSON
State CA
ZIP 90746
Accounting period End 12
Primary contact name CHRISTOPHER SANDERS SR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTOPHER SANDERS
PRESIDENT
20103 NESTOR AVENUE
CARSON CA 90746

Officer/Director/Trustee Two

TINIESHA BROOKS
SECRETARY
20103 NESTOR AVENUE
CARSON CA 90746

Officer/Director/Trustee Three

ERICKA HERNANDEZ
CFO
20103 NESTOR AVENUE
CARSON CA 90746

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/18/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E31 - Group Health Practice (Health Maintenance Organizations)
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 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 CHRISTOPHER SANDERS
Signature Title PRESIDENT
Signature Date 6/11/18

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