FORM 1023-EZ for NWA DOMESTIC VIOLENCE EMERGENCY SERVICES

Field Data
EIN 47-3595671
Case Number EO-2016025-000175
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NWA DOMESTIC VIOLENCE EMERGENCY SERVICES
Organization’s Mailing Address 3826 NORTH FRONT STREET
City FAYETTEVILLE
State AR
ZIP 72703
Accounting period End 12
Primary contact name ASHLEY WEAVER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PATRICIA COLLINS
PRESIDENT
PO BOX 108
FAYETTEVILLE AR 72702

Officer/Director/Trustee Two

ASHLEY WEAVER
EXECUTIVE DIRECTOR
20329 CANARY DRIVE
ROGERS AR 72756

Officer/Director/Trustee Three

KIM JONES
RN, CASE MANAGER
12950 NORTH JACKSON HWY
LINCOLN AR 72744

Officer/Director/Trustee Four

LORI DEVECSERY
DIRECTOR OF SALES
2651 S COLLEGE DRIVE
FAYETTEVILLE AR 72701

Officer/Director/Trustee Five

CAROL COLLINS
SENIOR COMMUNITY OUTREACH DIRECTOR
506 SOUTH WEST AVE
LINCOLN AR 72744

Organization’s website NWABREAKTHESILENCE.COM
Organization’s email NWABREAKTHESILENCE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/23/2015
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I70 - Protection Against, Prevention of Neglect, Abuse, Exploitation
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
Signature Title
Signature Date

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