FORM 1023-EZ for BLOCKHIVE INC

Field Data
EIN 82-2096772
Case Number EO-2017275-000455
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLOCKHIVE INC
Organization’s Mailing Address 749 SOUTH PROVIDENCE LANE
City ROUND LAKE
State IL
ZIP 60073
Accounting period End 12
Primary contact name KAMAU PHILLIPS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KAMAU PHILLIPS
CHIEF OPERATING OFFICER
749 SOUTH PROVIDENCE LANE
ROUND LAKE IL 60073

Officer/Director/Trustee Two

MELVIN PETTIES
CHIEF EXECUTIVE OFFICER
20136 OREGON TRAIL
OLYMPIA FIELDS IL 60461

Officer/Director/Trustee Three

NINEVEH ZOUDO
EXECUTIVE MARKETING DIRECTOR
8139 NORTH KILPATRICK
SKOKIE IL 60076

Officer/Director/Trustee Four

PAMELA FALETI
EXECUTIVE PROGRAM DIRECTOR
5340 SOUTH HYDE PARK BLVD
CHICAGO IL 60615

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/23/2017
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code U03 - Professional Societies, Associations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: Yes
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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