FORM 1023-EZ for THE BLACK CLOVER FOUNDATION
| Field | Data |
|---|---|
| EIN | 84-3819369 |
| Case Number | EO-2019350-000182 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | THE BLACK CLOVER FOUNDATION |
| Organization’s Mailing Address | 250 MACARTHUR BLVD |
| City | SAN LEANDRO |
| State | CA |
| ZIP | 94577 |
| Accounting period End | 12 |
| Primary contact name | TOURIA JAVID MOBIN |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
PAUL CHAMBERS
PRESIDENT
250 MACARTHUR BLVD
SAN LEANDRO CA 94577
Officer/Director/Trustee Two
STEVE PETERSON
SECRETARY
250 MACARTHUR BLVD
SAN LEANDRO CA 94577
Officer/Director/Trustee Three
GASPER LOWERY
TREASURER
1271 WASHINGTON AVENUE 452
SAN LEANDRO CA 94577
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 11/12/2019 |
| Organization Incorporation State | CA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | J99 - Employment, Job Related 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 | Yes |
| Donation of funds | No |
| Conducting Activities Outside of United States | No |
| Financial transactions with officers | Yes |
| 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 | PAUL CHAMBERS |
| Signature Title | PRESIDENT |
| Signature Date | 12/12/2019 |
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