FORM 1023-EZ for BLACK HEALTH TRUST

Field Data
EIN 85-1517330
Case Number EO-2021055-000039
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK HEALTH TRUST
Organization’s Mailing Address 447 N PRAIRIE AVE
City INGLEWOOD
State CA
ZIP 90301
Accounting period End 12
Primary contact name MARLON JONES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RANDALL MAXEY
DIRECTOR
447 N PRAIRIE AVE
INGLEWOOD CA 90301

Officer/Director/Trustee Two

MARLON JONES
DIRECTOR
447 N PRAIRIE AVE
INGLEWOOD CA 90301

Officer/Director/Trustee Three

CARL BROOKS
DIRECTOR
447 N PRAIRIE AVE
INGLEWOOD CA 90301

Officer/Director/Trustee Four

JUDITH MAXEY
DIRECTOR
447 N PRAIRIE AVE
INGLEWOOD CA 90301

Officer/Director/Trustee Five

BARBARA NABRIT-STEPHENS
DIRECTOR
447 N PRAIRIE AVE
INGLEWOOD CA 90301

Organization’s website WWW.BLACKHEALTHTRUST.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/24/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
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 No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MARLON JONES
Signature Title DIRECTOR
Signature Date 12/23/2020

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