FORM 1023-EZ for REVIVE

Field Data
EIN 38-4025415
Case Number EO-2017047-000116
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name REVIVE
Organization’s Mailing Address 2117 AMERICANA AVE
City MUSCATINE
State IA
ZIP 52761-2535
Accounting period End 12
Primary contact name NORMA MORRISON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HARRY KNUTSEN
TREASURER
308 N MAIN ST
WALCOTT IA 52773-8564

Officer/Director/Trustee Two

NORMA MORRISON
CO-CHAIR
2117 AMERICANA AVE
MUSCATINE IA 52761-2535

Officer/Director/Trustee Three

MICHAEL GUDKA
CO-CHAIR
201 3RD AVE NE
CLARINDA IA 50525-1111

Officer/Director/Trustee Four

RICK HOFMEYER
VICE-CHAIR
601 S MAIN ST
FAYETTE IA 52142-7623

Officer/Director/Trustee Five

ROBERT GAMBLE
WEBMASTER
595 S 60TH ST
WEST DES MOINES IA 50266-5720

Organization’s website WWW.REVIVEUMC.ORG
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/12/2013
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 Yes
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
Signature Title
Signature Date

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