FORM 1023-EZ for BLACK LEADERSHIP NETWORK

Field Data
EIN 31-1501799
Case Number EO-2018106-000722
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK LEADERSHIP NETWORK
Organization’s Mailing Address 17903 GABLE OAK LANE
City CYPRESS
State TX
ZIP 77433
Accounting period End 8
Primary contact name DEBBIE SAMUELS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GEORGE GAMBLE
BOARD CHAIR
1024 GOLDFISH AVENUE
SUGAR LAND TX 77478

Officer/Director/Trustee Two

DEBBIE SAMUELS
PRESIDENT
17903 GABLE OAK LANE
CYPRESS TX 77433

Officer/Director/Trustee Three

MYRA CONLEY
TREASURER
339 SHADY ROCK LANE
HOUSTON TX 77015

Officer/Director/Trustee Four

LOUIS WILLIAMS
FACULTY CHAIR
2935 POPLAR CREEK LANE
PEAR LAND TX 77584

Officer/Director/Trustee Five

TRACIE BRISCOE
SECRETARY
11000 GATESDEN DRIVE APT 116
HOUSTON TX 77377

Organization’s website WWW.UH.EDU/BLN
Organization’s email BLN@UH.EDU
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/27/97
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B99 - Education 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 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name DEBBIE SAMUELS
Signature Title PRESIDENT
Signature Date 4/3/18

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