FORM 1023-EZ for SANTA BARBARA HOSPITAL MUSEUM CORPORATION

Field Data
EIN 84-2386591
Case Number EO-2019234-000229
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SANTA BARBARA HOSPITAL MUSEUM CORPORATION
Organization’s Mailing Address 21 SPANISH STREET
City SAINT AUGUSTINE
State FL
ZIP 32084
Accounting period End 12
Primary contact name KEVIN ROSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEVIN ROSE
PRESIDENT
1725 WINDOVER PLACE
SAINT AUGUSTINE FL 32092

Officer/Director/Trustee Two

ANGELA LIVELY-ROSE
VICE-PRESIDENT
1725 WINDOVER PLACE
SAINT AUGUSTINE FL 32092

Officer/Director/Trustee Three

JO ROSE
SECRETARY
239 E BUFFALO BLUFF RD NO 147
SATSUMA FL 32189

Organization’s website WWW.SBHMUSEUM.COM
Organization’s email KEVIN@SPYGLASSTRAVEL.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/28/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A50 - Museum, Museum Activities
Organization’s purpose Charitable: No
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 Yes
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 KEVIN ROSE
Signature Title PRESIDENT
Signature Date 8/20/19

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