FORM 1023-EZ for CHILDRENS MUSEUM OF THE BLACK HILLS

Field Data
EIN 81-2821185
Case Number EO-2016190-000795
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHILDRENS MUSEUM OF THE BLACK HILLS
Organization’s Mailing Address PO BOX 9187
City RAPID CITY
State SD
ZIP 57709-9187
Accounting period End 4
Primary contact name LILLIAN BRUCKNER PRESIDENT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LILLIAN BRUCKNER
PRESIDENT
8028 SANDLILY COURT
RAPID CITY SD 57702

Officer/Director/Trustee Two

AMY FINK
TREASURER
627 NORTHERN LIGHTS BLVD APT 4205
BOX ELDER SD 57719

Officer/Director/Trustee Three

SKYE POTTER
VICE PRESIDENT
3481 WESSON ROAD
RAPID CITY SD 57703

Officer/Director/Trustee Four

MELISSA CROUCH
SECRETARY
4707 STEAMBOAT CIRCLE
RAPID CITY SD 57702

Organization’s website
Organization’s email CHILDRENSMUSEUMBH@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/5/2016
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A52 - Children's Museums
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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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