FORM 1023-EZ for PEACEFUL VALLEY BAPTIST CAMP

Field Data
EIN 47-2082660
Case Number EO-2015096-000131
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PEACEFUL VALLEY BAPTIST CAMP
Organization’s Mailing Address 22199 PEACEFUL VALLEY DRIVE
City SAINT MARY
State MO
ZIP 63673
Accounting period End 12
Primary contact name DOUG SIMMINGER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DOUG SIMMINGER
CHAIRMAN
212 SOUTH HIGH STREET
JACKSON MO 63755

Officer/Director/Trustee Two

GERRY DENTON
VICE-CHAIRMAN
HIGHWAY K
PATTON MO 63662

Officer/Director/Trustee Three

CATHY COFFMAN
TREASURER
22307 STATE ROAD N
SAINT MARY MO 63673

Officer/Director/Trustee Four

TOM SCHMIDT
RECORDING-SECRETARY
408 NORTH OAK STREET
ADVANCE MO 63730

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2014
Organization Incorporation State MO
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 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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