FORM 1023-EZ for CHAPLAINUSA

Field Data
EIN 81-2614196
Case Number EO-2016214-000360
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHAPLAINUSA
Organization’s Mailing Address 1026 SANTA CLARA
City BROWNWOOD
State TX
ZIP 76801
Accounting period End 12
Primary contact name DAVID DIERKS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PHIL LECONTE
DIRECTOR
1104 WEST 7TH STREET
AUSTIN TX 78703

Officer/Director/Trustee Two

DAVID FAIR
DIRECTOR
1026 SANTA CLARA
BROWNWOOD TX 76801

Officer/Director/Trustee Three

ANDREW TOOPES
DIRECTOR
334 SYLVAN CIRCLE
BOWLING GREEN KY 42101

Officer/Director/Trustee Four

TERRY MORGAN
DIRECTOR
3768 MAGNOLIA STREET
LOOMIS CA 95650

Officer/Director/Trustee Five

CARY FRIEDMAN
DIRECTOR
139 ASCENSION STREET
PASSAIC NJ 07055

Organization’s website WWW.CHAPLAINUSA.ORG
Organization’s email CONTACT@CHAPLAINUSA.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/27/2015
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X01 - Alliance/Advocacy Organizations
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 Yes
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 Yes
One Third Support Gifts No
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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