FORM 1023-EZ for BEVERLY BLOSSOM FOUNDATION

Field Data
EIN 47-3587572
Case Number EO-2018242-000276
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BEVERLY BLOSSOM FOUNDATION
Organization’s Mailing Address 345 N CANAL ST STE 1401
City CHICAGO
State IL
ZIP 60606-1366
Accounting period End 12
Primary contact name MICHAEL BLOSSOM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL BLOSSOM
PRESIDENT
345 N CANAL ST STE 1401
CHICAGO IL 60606-1366

Officer/Director/Trustee Two

PATRICIA KNOWLES
SECRETARY
1 SHUMAN CIRCLE
URBANA IL 61801-6219

Officer/Director/Trustee Three

PETER MCDOWELL
TREASURER
1525 ALLESANDRO
LOS ANGELES CA 90026-2402

Officer/Director/Trustee Four

DOUGLAS NIELSEN
DIRECTOR
1001 E 17TH ST APT 216
TUCSON IL 85719-6770

Officer/Director/Trustee Five

HENNING RUBSAM
DIRECTOR
1425 3RD AVE APT 3C
NEW YORK NY 10028-1867

Organization’s website WWW.BEVERLYBLOSSOM.ORG
Organization’s email CONTACT@BEVERLYBLOSSOM.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/16/15
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A62 - Dance
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MICHAEL BLOSSOM
Signature Title PRESIDENT
Signature Date 8/28/18

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