FORM 1023-EZ for UPPER ROOM FELLOWSHIP

Field Data
EIN 36-4801067
Case Number EO-2019176-000239
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name UPPER ROOM FELLOWSHIP
Organization’s Mailing Address 28850 VALLEJO AVE
City TEMECULA
State CA
ZIP 92592
Accounting period End 12
Primary contact name PERRY R LOUCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PERRY LOUCK
CEO
28850 VALLEJO AVE
TEMECULA CA 92592

Officer/Director/Trustee Two

SUSAN LOUCK
SECRETARY
28850 VALLEJO AVE
TEMECULA CA 92592

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/14
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 PERRY LOUCK
Signature Title CEO
Signature Date 6/20/19

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