FORM 1023-EZ for REVIVAL ARKANSAS INC

Field Data
EIN 83-2409910
Case Number EO-2018318-000014
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name REVIVAL ARKANSAS INC
Organization’s Mailing Address 205 W FRONT STREET
City HEBER SPRINGS
State AR
ZIP 72543
Accounting period End 11
Primary contact name MARCUS BOYD ROTHWELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARCUS ROTHWELL
DIRECTOR
205 W FRONT STREET
HEBER SPRINGS AR 72543-2501

Officer/Director/Trustee Two

CHAD GAITHER
DIRECTOR
1719 WEDGEWOOD RD
HEBER SPRINGS AR 72543-2501

Officer/Director/Trustee Three

JASON ARNOLD
DIRECTOR
24 EVERGREEN DR
HEBER SPRINGS AR 72543-2501

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/1/18
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X12 - Fund Raising and/or Fund Distribution
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 No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
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 MARCUS ROTHWELL
Signature Title DIRECTOR
Signature Date 11/5/18

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