FORM 1023-EZ for CAPT SEAN GRIMES PA STUDENT SOCIETY& PA PROGRAM

Field Data
EIN 84-3149733
Case Number EO-2020041-000218
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CAPT SEAN GRIMES PA STUDENT SOCIETY& PA PROGRAM
Organization’s Mailing Address 101 ELM AVE SE
City ROANOKE
State VA
ZIP 24013-2222
Accounting period End 12
Primary contact name JARED WILLIAMSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GABRIELLE LEWI LEWIS
PRESIDENT
101 ELM AVE SE
ROANOKE VA 24013-2222

Officer/Director/Trustee Two

JARED WILLIAMSON
TREASURER
101 ELM AVE SE
ROANOKE VA 24013-2222

Officer/Director/Trustee Three

CIERRA LUND
CO-VICE PRESIDENT
101 ELM AVE SE
ROANOKE VA 24013-2222

Officer/Director/Trustee Four

STEVEN ABERCROMBIE
CO-VICE PRESIDENT
101 ELM AVE SE
ROANOKE VA 24013-2222

Officer/Director/Trustee Five

RACHEL RICKE
FUNDRAISING COORDINATOR
101 ELM AVE SE
ROANOKE VA 24013-2222

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/24/2019
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H03 - Professional Societies, Associations
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: Yes
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 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 JARED WILLIAMSON
Signature Title TREASURER
Signature Date 2/6/2020

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