FORM 1023-EZ for THE SUSAN R BLACK CANCER FOUNDATION
| Field | Data |
|---|---|
| EIN | 86-1695887 |
| Case Number | EO-2021084-001326 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | THE SUSAN R BLACK CANCER FOUNDATION |
| Organization’s Mailing Address | 12916 HOWE DRIVE |
| City | LEAWOOD |
| State | KS |
| ZIP | 66209 |
| Accounting period End | 12 |
| Primary contact name | JOHN BLACK |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JOHN BLACK
PRESIDENT
12916 HOWE DRIVE
LEAWOOD KS 66209
Officer/Director/Trustee Two
LAUREN CLAFLIN
VICE PRESIDENT
12740 DELMAR DRIVE
LEAWOOD KS 66209
Officer/Director/Trustee Three
MARY KATHERINE FOX
TREASURER
12635 JUNIPER CIRCLE
LEAWOOD KS 66209
Officer/Director/Trustee Four
KATHERINE DOWNS
SECRETARY
4007 W 140TH STREET
LEAWOOD KS 66224
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/26/2021 |
| Organization Incorporation State | KS |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | G30 - Cancer |
| Organization’s purpose | Charitable: Yes Religious: No Educational: No 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 | JOHN BLACK |
| Signature Title | PRESIDENT |
| Signature Date | 2/3/2021 |
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