FORM 1023-EZ for KESITAH ORPHAN HOMES

Field Data
EIN 30-0373907
Case Number EO-2016356-000303
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KESITAH ORPHAN HOMES
Organization’s Mailing Address PO BOX 35
City MITCHELL
State NE
ZIP 69357
Accounting period End 7
Primary contact name BRIAN BAKER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRIAN BAKER
PRESIDENT
80493 COUNTY RD 11
MITCHELL NE 69357

Officer/Director/Trustee Two

DAWN WAYMAN
TRESURER
6839 GOLDCREST COURT
COLORADO SPRINGS CO 80919

Officer/Director/Trustee Three

GREG BAKER
ADVISOR
12042 SE SUNNYSIDE ROAD NO 689
CLACKAMAS OR 97015

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/5/2006
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
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 Yes
Conducting Activities Outside of United States Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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