FORM 1023-EZ for SHINE 5 16

Field Data
EIN 84-2169673
Case Number EO-2020203-000197
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SHINE 5 16
Organization’s Mailing Address 83 VALLEY RD
City BERWICK
State PA
ZIP 18603
Accounting period End 7
Primary contact name JUDITH E LYNN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUDITH E LYNN
PRESIDENT
83 VALLEY RD
BERWICK PA 18603

Officer/Director/Trustee Two

EVANGELINE HENRIE
VICE PRESIDENT
15 DAIRY RD
BERWICK PA 18603

Officer/Director/Trustee Three

KATIE LYNN
SECRETARY
325 E 6TH ST
BERWICK PA 18603

Officer/Director/Trustee Four

AMY HONTZ
TREASURER
795 RIDGE RD
ORANGEVILLE PA 17859

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/1/2019
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X12 - Fund Raising and/or Fund 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 Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity Yes
Disaster relief assistance Yes
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 JUDITH E LYNN
Signature Title PRESIDENT
Signature Date 7/16/2020

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