FORM 1023-EZ for BLACK LIVES MATTER RHODE ISLAND

Field Data
EIN 85-2561329
Case Number EO-2021092-001267
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK LIVES MATTER RHODE ISLAND
Organization’s Mailing Address 225 MAIN STREET
City PAWTUCKET
State RI
ZIP 02840
Accounting period End 8
Primary contact name ANN CLANTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GARY DANTZLER
PRESIDENT
327 PROSPECT STREET
PAWTUCKET RI 02860

Officer/Director/Trustee Two

JAMAAL BULLOCK
DIRECTOR
31 SCITUATE FARMS DRIVE
CRANSTON RI 02921

Officer/Director/Trustee Three

DAVID OCONNOR
DIRECTOR
374 EATON STREET
PROVIDENCE RI 02908

Officer/Director/Trustee Four

IMAN PAHLAVI
DIRECTOR
28 RUMSTICK DRIVE
BARRINGTON RI 02806

Officer/Director/Trustee Five

WILL BOZEMAN
DIRECTOR
327 PROSPECT STREET
PAWTUCKET RI 02860

Organization’s website HTTPS://WWW.BLACKLIVESMATTERRI.ORG
Organization’s email BERNICE@BLMRI.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/20/2020
Organization Incorporation State RI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code R20 - Civil Rights, Advocacy for Specific Groups
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 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 GARY DANTZLER
Signature Title PRESIDENT
Signature Date 2/27/2021

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