FORM 1023-EZ for BLACK LIVES MATTER RI INC

Field Data
EIN 85-1629971
Case Number EO-2021099-000165
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK LIVES MATTER RI INC
Organization’s Mailing Address PO BOX 25065
City PROVIDENCE
State RI
ZIP 02905
Accounting period End 12
Primary contact name ADRIAN V LOMBARD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VICTOR D LOMBARD
PRESIDENT / DIRECTOR
16 HENRY STREET
CRANSTON RI 02905

Officer/Director/Trustee Two

ADRIAN V LOMBARD
TREASURER / DIRECTOR
16 HENRY STREET
CRANSTON RI 02905

Officer/Director/Trustee Three

JILLIAN A WALASKI
SECRETARY / DIRECTOR
16 HENRY STREET
CRANSTON RI 02905

Officer/Director/Trustee Four

BERNARD A TRIBBLE JR
DIRECTOR
19 CHAPEL TERRACE APT 404
NEWPORT RI 02840

Officer/Director/Trustee Five

MARK FISHER
DIRECTOR
24 BUFFALO COURT
PROVIDENCE RI 02909

Organization’s website WWW.BLMRI.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/25/2020
Organization Incorporation State DE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other 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 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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ADRIAN V LOMBARD
Signature Title TREASURER / DIRECTOR
Signature Date 3/18/2021

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