FORM 1023-EZ for TEENS TO CAMP

Field Data
EIN 83-3778317
Case Number EO-2019115-000423
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TEENS TO CAMP
Organization’s Mailing Address 18915 DEER HOLLOW RD
City HIDDEN VALLEY LAKE
State CA
ZIP 95467-8029
Accounting period End 12
Primary contact name RODGER MARTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RODGER MARTIN
DIRECTOR/ PRESIDENT
18915 DEER HOLLOW RD
HIDDEN VALLEY LK CA 95467-8029

Officer/Director/Trustee Two

ROD MARTIN
DIRECTOR/ TREASURER
18189 DEER HOLLOW RD
HIDDEN VALLEY LK CA 95467-8029

Officer/Director/Trustee Three

GREG SOSKIN
DIRECTOR/ SECRETARY
14062 WOODLAND DR
CLEARLAKE CA 95422-8029

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/17/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P58 - Gift Distribution
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 RODGER MARTIN
Signature Title DIRECTOR/ PRESIDENT
Signature Date 4/23/19

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