FORM 1023-EZ for BERKELEY NORTH HISTORICAL CULTURALASSOCIATION

Field Data
EIN 47-1666667
Case Number EO-2015208-000480
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BERKELEY NORTH HISTORICAL CULTURALASSOCIATION
Organization’s Mailing Address 153 WALNUT WAY
City PINEVILLE
State SC
ZIP 29468-3060
Accounting period End 6
Primary contact name THOMAS KEITH GOURDIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

THOMAS KEITH GOURDIN
PRESIDENT
153 WALNUT WAY
PINEVILLE SC 24968-3060

Officer/Director/Trustee Two

BETTY H GOURDIN
SECRETARY
153 WALNUT WAY
PINEVILLE SC 24968-3060

Officer/Director/Trustee Three

SHELLIE JOHNSON
TREASURER
1121 GRAHAM STREET
ST STEPHEN SC 29479-0662

Officer/Director/Trustee Four

DAVID R DUBOSE
VICE PRESIDENT
100 RHETTS WAY
SUMMERVILLE SC 29485-7845

Officer/Director/Trustee Five

BUTCH DAMON
BOARD MEMBER
1108 OLD MILL ROAD
ST STEPHEN SC 29479-3000

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2015
Organization Incorporation State SC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A80 - Historical Societies, Related Historical Activities
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 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
Signature Title
Signature Date

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