FORM 1023-EZ for SOUTHERN INDIANA VETERAN LIVING ANDREHABILITATION FACILITY INC

Field Data
EIN 87-1739563
Case Number EO-2021202-000150
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SOUTHERN INDIANA VETERAN LIVING ANDREHABILITATION FACILITY INC
Organization’s Mailing Address 7075 STATE ROAD 66
City LEAVENWORTH
State IN
ZIP 47137-8309
Accounting period End 12
Primary contact name CHASE SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES FRAZE
PRESIDENT
8985 S INDIAN RIDGE ROAD
LEAVENWORTH IN 47137-8224

Officer/Director/Trustee Two

DANIEL CRECELIUS
VICE PRESIDENT
2271 N CRECELIUS ROAD
MILLTOWN IN 47145-7827

Officer/Director/Trustee Three

DONNA SMITH
SECRETARY
1600 N LIBERTY VIEW ROAD
MILLTOWN IN 47145-7838

Officer/Director/Trustee Four

RICK SPRINKLE
TREASURER
7075 STATE ROAD 66
LEAVENWORTH IN 47137-8309

Officer/Director/Trustee Five

CHASE SMITH
ADVISOR
1600 N LIBERTY VIEW ROAD
MILLTOWN IN 47145-7838

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/17/2019
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
Organization’s purpose Charitable: Yes
Religious: No
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 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 CHASE SMITH
Signature Title ADVISOR
Signature Date 7/19/2021

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