FORM 1023-EZ for KQBM BLUE MOUNTAIN RADIO

Field Data
EIN 38-4125590
Case Number EO-2020013-000224
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KQBM BLUE MOUNTAIN RADIO
Organization’s Mailing Address P O BOX 574
City WEST POINT
State CA
ZIP 95255
Accounting period End 12
Primary contact name CATHERINE LAMBIE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARK DYKEN
CHAIR
4087 PONDEROSA WAY
ANGELS CAMP CA 95222

Officer/Director/Trustee Two

CATHERINE LAMBIE
VICE CHAIR
P O BOX 64
WILSEYVILLE CA 95257

Officer/Director/Trustee Three

JENNIFER BRUNEEL
BD MEMBER
P O BOX 1621
SAN ANDREAS CA 95249

Officer/Director/Trustee Four

DONALD MITCHELL
SECRETARY
P O BOX 935
WEST POINT CA 95255

Officer/Director/Trustee Five

STEVE MICHELSEN
BD MEMBER
15517 BARN HOLLOW RD
NEVADA CITY CA 95959

Organization’s website KQBM.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/19/2019
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A34 - Radio
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 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 CATHERINE LAMBIE
Signature Title VICE CHAIR
Signature Date 1/9/2020

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