FORM 1023-EZ for MOUNTAIN HOME VILLAGE COMMUNITY CENTER

Field Data
EIN 82-3339802
Case Number EO-2018102-000146
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MOUNTAIN HOME VILLAGE COMMUNITY CENTER
Organization’s Mailing Address 1842 MENTONE BLVD SUITE 653
City MENTONE
State CA
ZIP 92359
Accounting period End 6
Primary contact name VICTORIA VANDERFORD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN GOODMAN
PRESIDENT
37037 COULTER PINE DR
MENTONE CA 92359

Officer/Director/Trustee Two

JACKIE SCARBOROUGH
BOARD MEMBER
36943 ALDER DR
MENTONE CA 92359

Officer/Director/Trustee Three

MISSY MARTIN
EVENT COORDINATOR
37044 OLD MILL CREEK RD
MENTONE CA 92359

Officer/Director/Trustee Four

CAROL BURGESS
BOARD MEMBER
36930 OLD MILL CREEK RD
MENTONE CA 92359

Officer/Director/Trustee Five

VICTORIA VANDERFORD
SECRETARY
36930 OLD MILL CREEK RD
MENTONE CA 92359

Organization’s website
Organization’s email MOUNTAIN.HOME.VILLAGE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/23/17
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T70 - Fund Raising Organizations That Cross Categories
Organization’s purpose Charitable: Yes
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 Yes
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 Yes
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 VICTORIA VANDERFORD
Signature Title SECRETARY
Signature Date 4/5/18

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