FORM 1023-EZ for SHALOM PASTORS RETREAT

Field Data
EIN 84-2483932
Case Number EO-2019268-000197
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SHALOM PASTORS RETREAT
Organization’s Mailing Address 417 PINE ST PO BOX 843
City PEMBERVILLE
State OH
ZIP 43450
Accounting period End 12
Primary contact name NANCY LEMBKE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NANCY LEMBKE
SEC/TREAS
417 PINE ST
PEMBERVILLE OH 43450

Officer/Director/Trustee Two

DANIEL LEMBKE
PRES.
417 PINE ST
PEMBERVILLE OH 43450

Officer/Director/Trustee Three

STEVE WILSON
VICE PRES
601 HIGHLAND RIDGE DR
CHINA GROVE NC 28023

Organization’s website
Organization’s email SHALOMRETREATS2019@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/23/19
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
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 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 NANCY LEMBKE
Signature Title SEC/TREAS
Signature Date 9/23/19

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