FORM 1023-EZ for HILLSIDE RETREAT CENTER

Field Data
EIN 47-3736045
Case Number EO-2016125-000078
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HILLSIDE RETREAT CENTER
Organization’s Mailing Address 22409 ELLIS DAVIS RD
City PRAIRIE HOME
State MO
ZIP 65068-2143
Accounting period End 12
Primary contact name WILLIAM SMART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WILLIAM SMART
PRESIDENT/CO-MANAGER
22409 ELLIS DAVIS RD
PRAIRIE HOME MO 65068-2143

Officer/Director/Trustee Two

SUSAN SMART
TREASURER/CO-MANAGER
22409 ELLIS DAVIS RD
PRAIRIE HOME MO 65068-2143

Officer/Director/Trustee Three

JO BLACK
SECRETARY
33680 107TH LANE
NELSON MO 65347

Officer/Director/Trustee Four

JOHN HOUMES
VICE PRESIDENT
2283 CONCORDIA DR
COLUMBIA MO 65203

Officer/Director/Trustee Five

SCOTT STEVER
DIRECTOR
4703 CEDAR COALS CT
COLUMBIA MO 65203

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/6/2015
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
Organization’s purpose Charitable: Yes
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 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 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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