FORM 1023-EZ for THE BLACK BURDELL INCORPORATED

Field Data
EIN 47-4844902
Case Number EO-2018273-000148
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE BLACK BURDELL INCORPORATED
Organization’s Mailing Address 2832 LOFTVIEW SQUARE
City ATLANTA
State GA
ZIP 30339
Accounting period End 12
Primary contact name DARREN BRUCE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DARREN BRUCE
CHIEF COMMUNICATIONS OFFICER
6401 SHELLMOUND ST APT 6116
EMERYVILLE CA 94608

Officer/Director/Trustee Two

HENDERSON JOHNSON II
CHIEF OPERATING OFFICER
2832 LOFTVIEW SQUARE
ATLANTA GA 30339

Officer/Director/Trustee Three

BRANDON MILLER
CHIEF EXECUTIVE OFFICER
5806 BIRCHBROOK DRIVE 210
DALLAS TX 75206

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/27/15
Organization Incorporation State GA
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: 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 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 DARREN BRUCE
Signature Title CHIEF COMMUNICATIONS OFFICER
Signature Date 9/26/18
EIN 47-4844902
Case Number EO-2015320-000195
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE BLACK BURDELL INCORPORATED
Organization’s Mailing Address 353 FERST DRIVE SUITE 141
City ATLANTA
State GA
ZIP 30332
Accounting period End 12
Primary contact name DARREN BRUCE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRANDON MILLER
PRESIDENT
6045 HEMBY RD
WEDDINGTON NC 28104

Officer/Director/Trustee Two

DARREN BRUCE
VICE PRESIDENT
9864 BOSQUE CREEK CIRCLE APT 101
TAMPA FL 33619

Officer/Director/Trustee Three

HENDERSON JOHNSON II
SECRETARY
4033 PRESTON OAKS PL
LITHONIA GA 30038

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/27/2015
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T31 - Community Foundations
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 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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