FORM 1023-EZ for DOUG G MENS RETREAT AT MALIBU INC

Field Data
EIN 47-2127736
Case Number EO-2015062-000160
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DOUG G MENS RETREAT AT MALIBU INC
Organization’s Mailing Address 11745 SAN ROSARITA COURT
City LAS VEGAS
State NV
ZIP 89138
Accounting period End 12
Primary contact name DENNIS HEALEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DENNIS HEALEY
PRESIDENT
11745 SAN ROSARITA CT
LAS VEGAS NV 89138

Officer/Director/Trustee Two

A MITCHELL FORTUNE
SECRETARY
612 STAR PINE DRIVE
LAS VEGAS NV 89144

Officer/Director/Trustee Three

DOUG GRAHAM
DIRECTOR
958 NORTHAMPTON ST
CAMBRIA CA 93428

Officer/Director/Trustee Four

TIMOTHY DETERS
DIRECTOR
70 CHERVIL VALLEY DR
LAS VEGAS NV 89138

Officer/Director/Trustee Five

JAMES REILLY
DIRECTOR
5217 SANTO AVE
LAS VEGAS NV 89108

Organization’s website WWW.DOUGGRETREAT.COM
Organization’s email DENNISCHEALEY@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/21/2014
Organization Incorporation State NV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B60 - Adult, Continuing Education
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 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 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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