FORM 1023-EZ for CIRCLE K HEALING AND REVIVAL BARN

Field Data
EIN 84-3815660
Case Number EO-2020217-000109
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CIRCLE K HEALING AND REVIVAL BARN
Organization’s Mailing Address 2705 K ST STE 1
City SACRAMENTO
State CA
ZIP 95816
Accounting period End 12
Primary contact name CLARK ALLISON ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AL KUHN
PRESIDENT, DIRECTOR
10140 BRUCEVILLE RD
ELK GROVE CA 95757

Officer/Director/Trustee Two

SUE KUHN
SECRETARY, DIRECTOR
10140 BRUCEVILLE RD
ELK GROVE CA 95757

Officer/Director/Trustee Three

JEFF CARTER
TREASURER, DIRECTOR
9209 LAGUNA LAKE WAY
ELK GROVE CA 95758

Officer/Director/Trustee Four

DEANNE CARTER
DIRECTOR
9209 LAGUNA LAKE WAY
ELK GROVE CA 95758

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/11/2019
Organization Incorporation State CA
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 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 AL KUHN
Signature Title PRESIDENT, DIRECTOR
Signature Date 8/2/2020

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