FORM 1023-EZ for SOUTH HILLS RETREAT CENTER DBA CAMPKUMBAYAH

Field Data
EIN 46-3136175
Case Number EO-2016237-000385
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTH HILLS RETREAT CENTER DBA CAMPKUMBAYAH
Organization’s Mailing Address 1708 HEYBURN AVE E
City TWIN FALLS
State ID
ZIP 83301-4916
Accounting period End 12
Primary contact name ROBERT S FORT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROGER BRAY
DIRECTOR
6 DEBBIE LANE
POCATELLO ID 83204

Officer/Director/Trustee Two

DARRELL DAY
DIRECTOR
6732
IDAHO FALLS ID 83401

Officer/Director/Trustee Three

SHERMAN HANSEN
DIRECTOR
P O BOX V
KIMBERLY ID 83341

Officer/Director/Trustee Four

ROBERT FORT
TREASURER
1708 HEYBURN AVE E
TWIN FALLS ID 83301-4916

Officer/Director/Trustee Five

PHILIP NELSON
DIRECTOR
142 LOS LAGOS
TWIN FALLS ID 83301-4916

Organization’s website
Organization’s email 23GRAYMAY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2013
Organization Incorporation State ID
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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