FORM 1023-EZ for HAVANA FOOD BANK

Field Data
EIN 83-2876468
Case Number EO-2019035-000866
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HAVANA FOOD BANK
Organization’s Mailing Address PO BOX 509
City DARDANELLE
State AR
ZIP 72834
Accounting period End 12
Primary contact name JAMES RIDENOUR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES RIDENOUR
PRESIDENT
105 W BROADWAY
HAVANA AR 72842

Officer/Director/Trustee Two

CHRIS BUCKMAN
VICE PRESIDENT
654 HWY 10
BELLEVILLE AR 72824

Officer/Director/Trustee Three

CRYSTAL GOODWIN
SECRETARY
135 BROWN RD
BELLEVILLE AR 72824

Officer/Director/Trustee Four

JANETTA ADAIR
TREASURER
10517 ROCKY POINT RD
HAVANA AR 72842

Officer/Director/Trustee Five

DOYLE BUCKMAN
COORDINATOR
14998 PINE RD
HAVANA AR 72842

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/4/18
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 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 JAMES RIDENOUR
Signature Title PRESIDENT
Signature Date 1/14/19

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