FORM 1023-EZ for PAGOSA SPRINGS COMMUNITY PRAYER ROOM INC

Field Data
EIN 47-3045155
Case Number EO-2015048-000109
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PAGOSA SPRINGS COMMUNITY PRAYER ROOM INC
Organization’s Mailing Address PO BOX 5523
City PAGOSA SPRINGS
State CO
ZIP 81147
Accounting period End 12
Primary contact name JUSTIN FRIE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JUSTIN FRIE
DIRECTOR
25 RAVEN COURT
PAGOSA SPRINGS CO 81147

Officer/Director/Trustee Two

RYAN SEARLE
ASSISTANT DIRECTOR
841 HERSCH AVE
PAGOSA SPRINGS CO 81147

Officer/Director/Trustee Three

KELLY MAC TIERNAN
SECRETARY/TREASURER
49 LOFTY COURT
PAGOSA SPRINGS CO 81147

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/2015
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
Organization’s purpose Charitable: Yes
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
Signature Title
Signature Date

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