FORM 1023-EZ for ARKANSAS IMMUNIZATION ACTION COALITION

Field Data
EIN 82-1825362
Case Number EO-2017172-000282
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ARKANSAS IMMUNIZATION ACTION COALITION
Organization’s Mailing Address 417 S VICTORY STREET
City LITTLE ROCK
State AR
ZIP 72201
Accounting period End 6
Primary contact name HEATHER MERCER--EXECUTIVE DIRECTOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER DILLAHA
M.D.--- CHAIR
417 S VICTORY STREET
LITTLE ROCK AR 72201

Officer/Director/Trustee Two

JOHN VINSON
TREASURER
417 S VICTORY STREET
LITTLE ROCK AR 72201

Officer/Director/Trustee Three

HEATHER MERCER
EXECUTIVE DIRECTOR
417 S VICTORY STREET
LITTLE ROCK AR 72201

Officer/Director/Trustee Four

KATHRYN SEARCY
COUNSEL
417 S VICTORY STREET
LITTLE ROCK AR 72201

Officer/Director/Trustee Five

LAURA WILLIAMS
M.D.-- MEDICAL DIRECTOR
417 VICTORY STREET
LITTLE ROCK AR 72201

Organization’s website WWW.IMMUNIZEAR.ORG
Organization’s email HEATHER@IMMUNIZEAR.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/30/2017
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
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 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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