FORM 1023-EZ for BLACK EXCELLENCE INC

Field Data
EIN 85-3546172
Case Number EO-2021021-000104
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK EXCELLENCE INC
Organization’s Mailing Address 5613 ASH AVENUE
City RAYTOWN
State MO
ZIP 64133
Accounting period End 12
Primary contact name ADRIENNE B HAYNES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CRAIG MOORE II
PRESIDENT
5613 ASH AVE
RAYTOWN MO 64133

Officer/Director/Trustee Two

DOLA GABRIEL
BOARD MEMBER
2057 N TREMONT ST
KANSAS CITY KS 66101

Officer/Director/Trustee Three

CARLA WALKER
BOARD MEMBER
7250 N MERSINGTON
GLADSTONE MO 64119

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/20/2020
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S30 - Economic Development
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) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CRAIG MOORE II
Signature Title PRESIDENT
Signature Date 11/25/2020

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