FORM 1023-EZ for DIVINE INTERVENTION JK

Field Data
EIN 61-1967250
Case Number EO-2021242-000256
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DIVINE INTERVENTION JK
Organization’s Mailing Address 13091 CHOCO RD
City APPLE VALLEY
State CA
ZIP 92308
Accounting period End 12
Primary contact name JAMES CAMPBELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES CAMPBELL
PRESIDENT
13091 CHOCO ROAD
APPLE VALLEY CA 92308

Officer/Director/Trustee Two

LAKEISHA KIDD- CAMPBELL
TREASURER
13091 CHOCO ROAD
APPLE VALLEY CA 92308

Officer/Director/Trustee Three

BRESHANA ROBERSON
SECRETARY
13091 CHOCO ROAD
APPLE VALLEY CA 92308

Officer/Director/Trustee Four

RICK BOYD
DIRECTOR
13091 CHOCO ROAD
APPLE VALLEY CA 92308

Officer/Director/Trustee Five

CHANTEL BOYD
BOARD MEMBER
13091 CHOCO ROAD
APPLE VALLEY CA 92308

Organization’s website
Organization’s email JAMCMPB9@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/20/2019
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O51 - Youth Community Service Clubs
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 Yes
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 JAMES CAMPBELL
Signature Title PRESIDENT
Signature Date 8/26/2021

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