FORM 1023-EZ for BLACK SWAMP ICE FROGS INC

Field Data
EIN 46-1395684
Case Number EO-2016301-000188
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLACK SWAMP ICE FROGS INC
Organization’s Mailing Address 1624 CLOUGH ST APT 20
City BOWLING GREEN
State OH
ZIP 43402
Accounting period End 12
Primary contact name SUSAN KEPLING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATHY DIBLING
PRESIDENT
219 EVERGREEN LN APT 42
BOWLING GREEN OH 43402

Officer/Director/Trustee Two

SUSAN KEPLING
SECRETARY
1624 CLOUGH ST APT 20
BOWLING GREEN OH 43402

Officer/Director/Trustee Three

CHERYL REED
VP
531 S SUMMIT
BOWLING GREEN OH 43402

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/15/2012
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code o99 - Youth Development N.E.C.
Organization’s purpose Charitable: No
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 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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