FORM 1023-EZ for CLINICAL PASTORAL EDUCATION INTERNATIONAL INC

Field Data
EIN 83-2857782
Case Number EO-2019035-000506
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLINICAL PASTORAL EDUCATION INTERNATIONAL INC
Organization’s Mailing Address PO BOX 9166
City FLEMING ISLAND
State FL
ZIP 32006
Accounting period End 12
Primary contact name DALLAS SPEIGHT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DALLAS SPEIGHT
PRESIDENT, DIRECTOR
1860 PARADISE MOORINGS BLVD
MIDDLEBURG FL 32068

Officer/Director/Trustee Two

RICH BEHERS
SECRETARY, TREASURER, DIRECTOR
8425 TOM COSTINE RD
LAKELAND FL 33809-2501

Officer/Director/Trustee Three

AL HENAGER
DIRECTOR
3901 RAINBOW BLVD OL-2001 MAIL ST
KANSAS CITY KS 66160

Officer/Director/Trustee Four

CJ MALONE
DIRECTOR
PO BOX 6372
SPRINGDALE AR 72766

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/11/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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 DALLAS SPEIGHT
Signature Title PRESIDENT, DIRECTOR
Signature Date 1/11/19

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