FORM 1023-EZ for PERGAMUM INC

Field Data
EIN 81-0849765
Case Number EO-2019108-000134
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PERGAMUM INC
Organization’s Mailing Address 303 W LYTLE 5 POINTS RD
City SPRINGBOROO
State OK
ZIP 45066
Accounting period End 12
Primary contact name ROY GLASS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROY GLASS
PRESIDENT
303 W LYTLE 5 POINTS RD
SPRINGBORO OH 45066

Officer/Director/Trustee Two

AMANDA GLASS
VICE-PRESIDENT
303 W LYTLE 5 POINTS RD
SPRINGBORO OH 45066

Officer/Director/Trustee Three

CHRISTOPHER SETSER
VICE-PRESIDENT
226 KENILWORTH AVE
DAYTON OH 45405

Organization’s website PERGAMUMHAUNT.WEEBLY.COM
Organization’s email PERGAMUMOH@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/2/15
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X21 - Protestant
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 ROY GLASS
Signature Title PRESIDENT
Signature Date 4/16/19

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