FORM 1023-EZ for BLUE AND GOLD ALUMNI SCHOLARSHIP

Field Data
EIN 85-3902437
Case Number EO-2021019-000134
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLUE AND GOLD ALUMNI SCHOLARSHIP
Organization’s Mailing Address 147 EAST EDISON DRIVE
City STATESVILLE
State NC
ZIP 28625
Accounting period End 12
Primary contact name D SAM DOBBINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BENJAMIN E MASTIN
PRESIDENT
4231 LAUREL RIDGE CIRCLE
WINSTON-SALEM NC 27107

Officer/Director/Trustee Two

DOUGLAS E REINHARDT
SECRETARY/TREASURER
147 E EDISON DRIVE
STATESVILLE NC 28625

Officer/Director/Trustee Three

D SAM DOBBINS
CPA
924 N BRIDGE ST
ELKIN NC 28621

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/16/2020
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name D SAM DOBBINS
Signature Title CPA
Signature Date 11/20/2020

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