FORM 1023-EZ for BLOC WORK

Field Data
EIN 83-2212477
Case Number EO-2018291-000078
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLOC WORK
Organization’s Mailing Address 901 DOUGLAS AVENUE
City GREENVILLE
State NC
ZIP 27834
Accounting period End 10
Primary contact name JAMAR JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMAR JACKSON
EXECUTIVE DIRECTOR
901 DOUGLAS AVENUE
GREENVILLE NC 27834

Officer/Director/Trustee Two

ROBERT HORTON
PRESIDENT
1240 B WEST RIDGE COURT
GREENVILLE NC 27834

Officer/Director/Trustee Three

MICHELLE RIDLEY
ADMINISTRATIVE DIRECTOR
3009 KINGSTON CIRCLE B5
GREENVILE NC 27834

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/6/17
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I20 - Crime Prevention N.E.C.
Organization’s purpose Charitable: Yes
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 Yes
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 Yes
Disaster relief assistance Yes
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 JAMAR JACKSON
Signature Title EXECUTIVE DIRECTOR
Signature Date 10/16/18

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