FORM 1023-EZ for BLACKWELL UNITED OUTREACH

Field Data
EIN 85-1653298
Case Number EO-2020183-000368
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACKWELL UNITED OUTREACH
Organization’s Mailing Address 120 S MAIN STREET/PO BOX 971
City BLACKWELL
State OK
ZIP 74631-0971
Accounting period End 6
Primary contact name STACIE GROSSARDT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STACIE GROSSARDT
DIRECTOR
PO BOX 971
BLACKWELL OK 74631-0971

Officer/Director/Trustee Two

TERRIE GRELL
PRESIDENT
13485 W PECKHAM
BRAMAN OK 74632

Officer/Director/Trustee Three

JAYLENE SOULEK
VICE PRESIDENT
22905 W CHRYSLER
NARDIN OK 74646

Officer/Director/Trustee Four

EMILY JANTZ
SECRETARY
303 W COLLEGE
BLACKWELL OK 74631

Officer/Director/Trustee Five

DEONNE GATES
SECRETARY ELECT
PO BOX 326
BLACKWELL OK 74631

Organization’s website BLACKWELLUNITED.ORG
Organization’s email BLACKWELLUNITEDOUTREACH@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/23/2020
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T12 - Fund Raising and/or Fund Distribution
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name STACIE GROSSARDT
Signature Title DIRECTOR
Signature Date 6/29/2020

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