FORM 1023-EZ for LIFE REVIVAL MINISTRIES

Field Data
EIN 81-4458075
Case Number EO-2017011-000376
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE REVIVAL MINISTRIES
Organization’s Mailing Address PO BOX 116
City NEWPORT
State MN
ZIP 55337-1185
Accounting period End 12
Primary contact name REVEREND JOHN HART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN HART
PRESIDENT, TREASURER, DIRECTOR
1813 SKYLINE DRIVE SOUTH
BURNSVILLE MN 55337-2964

Officer/Director/Trustee Two

SANDRA ALBRIGHT
SECRETARY
962 80TH AVENUE
ROBERTS MN 54023

Officer/Director/Trustee Three

REVEREND WAYNE BREDAHL
DIRECTOR
3451 SEVEN OAKS STREET
RIVER FALLS MN 54022

Officer/Director/Trustee Four

DOCTOR JOHN BORSHEIM
DIRECTOR
3915 TRAIL POINT COURT
PRIOR LAKE MN 55372

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/17/2016
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
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
Signature Title
Signature Date

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