FORM 1023-EZ for SERRA CLUB OF ARLINGTON VA

Field Data
EIN 20-1402152
Case Number EO-2020113-000018
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SERRA CLUB OF ARLINGTON VA
Organization’s Mailing Address 333 WEST WACKER DRIVE
City CHICAGO
State IL
ZIP 60606
Accounting period End 5
Primary contact name ROBERT CAMPNEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

H LAWRENCE CLARK JR
PRESIDENT
332 N COLUMBUS STREET
ALEXANDRIA VA 22314

Officer/Director/Trustee Two

THADDEUS GODLEWSKI
TREASURER
5110 WHISPER WILLOW DRIVE
FAIRFAX VA 22030-8206

Officer/Director/Trustee Three

ELIZABETH SCHEUREN
PRESIDENT-ELECT
1402 RUFFNER ROAD
ALEXANDRIA VA 22302-4217

Officer/Director/Trustee Four

JANICE HOFSTEE
SECRETARY
43 HOLLY BERRY ROAD
FREDERICKSBURG VA 22406

Officer/Director/Trustee Five

ROBERT CAMPNEY
TRUSTEE
15918 PATRICK AVE
OMAHA NE 68116

Organization’s website
Organization’s email CAMPNEYBOB@COX.NET
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/15/2005
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X22 - Roman Catholic
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 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 Yes
Correctness Declaration Yes
Signature Name ROBERT CAMPNEY
Signature Title TRUSTEE
Signature Date 4/18/2020

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