FORM 1023-EZ for BLACK OAK FOUNDATION INC

Field Data
EIN 83-2615822
Case Number EO-2018333-000110
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK OAK FOUNDATION INC
Organization’s Mailing Address 4009 BEAVER CREEK ROAD
City ALPHARETTA
State GA
ZIP 30022-8333
Accounting period End 12
Primary contact name PATRICIA MOORE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MONICA FISHER
TREASURER
20 CENTURY ST
STAFFORD VA 22554-8837

Officer/Director/Trustee Two

MONIQUE SIMPSON
SECRETARY
3510A MACON WAY
TRIANGLE VA 22172-1110

Officer/Director/Trustee Three

PATRICIA MOORE
PRESIDENT
4009 BEAVER CREEK ROAD
ALPHARETTA GA 30022-8333

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/14/18
Organization Incorporation State GA
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: No
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 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 PATRICIA MOORE
Signature Title PRESIDENT
Signature Date 11/27/18

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