FORM 1023-EZ for CAMP CREEK CEMETERY ASSOCIATION

Field Data
EIN 85-1628461
Case Number EO-2021189-000150
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CAMP CREEK CEMETERY ASSOCIATION
Organization’s Mailing Address 212 SHANNON ROAD
City MURPHYSBORO
State IL
ZIP 62966-4062
Accounting period End 12
Primary contact name CAROL BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DON SHANNON
PRESIDENT
117 KING HILL ROAD
MURPHYSBORO IL 62966-4062

Officer/Director/Trustee Two

CAROL BROWN
CFO
212 SHANNON ROAD
MURPHYSBORO IL 62966-4062

Officer/Director/Trustee Three

CLAUDE SHANNON
DIRECTOR
203 SHANNON ROAD
MURHPYSBORO IL 62966-4062

Officer/Director/Trustee Four

MARK KINDER
DIRECTOR
1619 NORTH BEACH ROAD
MCHENRY IL 60050

Officer/Director/Trustee Five

SARAH ALLEN
DIRECTOR
2309 TWILIGHT CIRCLE
PLANO TX 75093

Organization’s website
Organization’s email CARGBROWN@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/22/2020
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y50 - Cemeteries, Burial Services
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 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 CAROL BROWN
Signature Title CFO
Signature Date 7/6/2021

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