FORM 1023-EZ for SERENITY CREEK RETREAT INC

Field Data
EIN 86-2740327
Case Number EO-2021119-000148
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SERENITY CREEK RETREAT INC
Organization’s Mailing Address 532 COURT HOUSE LANDING RD
City KING AND QUEEN CH
State VA
ZIP 23085
Accounting period End 12
Primary contact name JOE BURCHAM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOE BURCHAM
PRESIDENT
532 COURT HOUSE LANDING RD
KING AND QUEEN CH VA 23085

Officer/Director/Trustee Two

DWIGHT SMITH
TREASURER
532 COURT HOUSE LANDING RD
KING AND QUEEN CH VA 23085

Officer/Director/Trustee Three

JAYE PARKER
SECRETARY
532 COURT HOUSE LANDING RD
KING AND QUEEN CH VA 23085

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/23/2021
Organization Incorporation State VA
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 JOE BURCHAM
Signature Title PRESIDENT
Signature Date 4/27/2021

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