FORM 1023-EZ for ACTIVE DAY SENIOR HEALTH CARE CENTER

Field Data
EIN 81-4550120
Case Number EO-2019042-000447
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ACTIVE DAY SENIOR HEALTH CARE CENTER
Organization’s Mailing Address 6475 PIERCE MANSE LOOP
City BENTON
State AR
ZIP 72019
Accounting period End 5
Primary contact name RENIA WHITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RENIA WHITE
EXECUTIVE DIRECTOR
6475 PIERCE MANSE LOOP
BENTON AR 72019

Officer/Director/Trustee Two

NAMONA WHITE
PRESIDENT
8900 SHILOH DRIVE
MABELVALE AR 72013

Officer/Director/Trustee Three

AMETRUS BEAL
SECRETARY
9001 NORTH RODNEY PARHAM APT C
LITTLE ROCK AR 72205

Officer/Director/Trustee Four

ANDREA WHITE
TREASURER
5813 BASELINE ROAD APT 186
LITTLE ROCK AR 72209

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/30/16
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P81 - Senior Centers, Services
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
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 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 RENIA WHITE
Signature Title EXECUTIVE DIRECTOR
Signature Date 2/8/19

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