FORM 1023-EZ for BLACK ICE SOFTBALL ORGANIZATION

Field Data
EIN 83-2348713
Case Number EO-2019031-000057
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK ICE SOFTBALL ORGANIZATION
Organization’s Mailing Address 1562 OLD STATE ROUTE 34
City TELFORD
State TN
ZIP 37690
Accounting period End 12
Primary contact name JEFF DEAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEFF DEAN
DIRECTOR
1562 OLD STATE ROUTE 34
TELFORD TN 37690-2724

Officer/Director/Trustee Two

ANTHONY ADAMS
TREASURER/SECRETARY
2753 HIGHWAY 81 SOUTH
JONESBOROUGH TN 37659-6505

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/29/18
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N63 - Baseball, Softball
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 ANTHONY ADAMS
Signature Title TREASURER/SECRETARY
Signature Date 1/8/19

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