FORM 1023-EZ for BLACK ELK CHARITABLE FOUNDATION INC
| Field | Data |
|---|---|
| EIN | 83-3074769 |
| Case Number | EO-2019045-000150 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | BLACK ELK CHARITABLE FOUNDATION INC |
| Organization’s Mailing Address | 2982 BIA 27 PO BOX 332 |
| City | PORCUPINE |
| State | SD |
| ZIP | 57772 |
| Accounting period End | 12 |
| Primary contact name | MYRON POURIER |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
MYRON POURIER
PRESIDENT
2982 BIA 27
PORCUPINE SD 57772
Officer/Director/Trustee Two
LISA MODRICK
DIRECTOR
300 SIXTH ST
RAPID CITY SD 57701
Officer/Director/Trustee Three
CHARLES TRIMBLE
DIRECTOR
8905 HICKORY
OMAHA NE 68124
Officer/Director/Trustee Four
KATHY WILSON
DIRECTOR
5242 AUTUMN PL
RAPID CITY SD 57702
Officer/Director/Trustee Five
MIKE NOLAN
DIRECTOR
6905 BALLARD AVE
LINCOLE NE 68507
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 12/21/18 |
| Organization Incorporation State | SD |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | A12 - Fund Raising and/or Fund Distribution |
| 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 | Yes |
| 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 | No |
| Benefit of College | No |
| Private Foundation 508(e) | Yes |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | MYRON POURIER |
| Signature Title | PRESIDENT |
| Signature Date | 2/12/19 |
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