FORM 1023-EZ for US PRISON DIARY MINISTRY

Field Data
EIN 83-2677503
Case Number EO-2019031-000157
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name US PRISON DIARY MINISTRY
Organization’s Mailing Address 27226 387TH AVE
City CORSICA
State SD
ZIP 57328
Accounting period End 12
Primary contact name SCOTT KELDERMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EVERT ADAMS
PRESIDENT
625 E MAIN ST
CORSICA SD 57328

Officer/Director/Trustee Two

ARNOUD VERGUNST
VICE PRESIDENT
276 S ELM ST
OAKFIELD WI 53065-9772

Officer/Director/Trustee Three

ARLEN BAKKER
SECRETARY
3020 310TH ST
HULL IA 51239-7532

Officer/Director/Trustee Four

SCOTT KELDERMAN
TREASURER
47925 281ST ST
CANTON SD 57013-5849

Officer/Director/Trustee Five

RICHARD ROZEBOOM
MEMBER
29037 485TH AVE
FAIRVIEW SD 57027-6206

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/26/18
Organization Incorporation State SD
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: 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 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 SCOTT KELDERMAN
Signature Title TREASURER
Signature Date 1/5/19

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