FORM 1023-EZ for BL4CK

Field Data
EIN 85-1342027
Case Number EO-2020169-000238
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BL4CK
Organization’s Mailing Address 4944 WEST BADGER LANE
City HERRIMAN
State UT
ZIP 84096
Accounting period End 12
Primary contact name CAREY DRISDOM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CAREY DRISDOM
EXECUTIVE DIRECTOR
4944 WEST BADGER LANE
HERRIMAN UT 84096

Officer/Director/Trustee Two

TERRENCE DRISDOM
DIRECTOR
575 E 4500 S
MILLCREEK UT 84107

Officer/Director/Trustee Three

TIMOTHY DRISDOM
DIRECTOR
575 E 4500 S
MILLCREEK UT 84107

Organization’s website BL4CK.ORG
Organization’s email INFO@CHANGINGLANESBAND.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/10/2020
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W70 - Leadership 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CAREY DRISDOM
Signature Title EXECUTIVE DIRECTOR
Signature Date 6/15/2020

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