FORM 1023-EZ for BLUE ROSE EMPOWERMENT GALLERIA INC

Field Data
EIN 47-5030693
Case Number EO-2016203-000099
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLUE ROSE EMPOWERMENT GALLERIA INC
Organization’s Mailing Address 4222 BRECKENRIDGE DRIVE
City WEST BLOOMFIELD
State MI
ZIP 48322
Accounting period End 12
Primary contact name KELLY JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KELLY JOHNSON
EXECUTIVE DIRECTOR
4222 BRECKENRIDGE DRIVE
WEST BLOOMFIELD MI 48323

Officer/Director/Trustee Two

FALLON JOHNSON
PRESIDENT
4222 BRECKENRIDGE DRIVE
WEST BLOOMFIELD MI 48323

Officer/Director/Trustee Three

DR GODIE WELLS
VICE PRESIDENT
4222 BRECKENRIDGE DRIVE
WEST BLOOMFIELD MI 48323

Officer/Director/Trustee Four

ANGELA KELLY
TREASURER
4222 BRECKENRIDGE DRIVE
WEST BLOOMFIELD MI 48323

Officer/Director/Trustee Five

DARINDA CLARK COLE
SECRETARY
4222 BRECKENRIDGE DRIVE
WEST BLOOMFIELD MI 48322

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/16/2015
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
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 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
Signature Title
Signature Date

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