FORM 1023-EZ for PAYSON HOMESS & HOMELESS VETERANS INITIATIVE

Field Data
EIN 84-4181341
Case Number EO-2020154-000044
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PAYSON HOMESS & HOMELESS VETERANS INITIATIVE
Organization’s Mailing Address PO BOX 2732
City PAYSON
State AZ
ZIP 85547
Accounting period End 12
Primary contact name PENNY DEGROOT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NEAL WORTHINGTON
PRESIDENT
2804 W NICKLAUS DRIVE
PAYSON AZ 85541

Officer/Director/Trustee Two

EMILY BRICE
VICE PRESIDENT
1309 N EASY STREET
PAYSON AZ 85541

Officer/Director/Trustee Three

PENNY DEGROOT
TREASURER
303 S ARROYO DRIVE
PAYSON AZ 85541

Officer/Director/Trustee Four

GARY BEDSWORTH
DIRECTOR
1129 S SYCAMORE CIRCLE
PAYSON AZ 85541

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/10/2020
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
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 PENNY DEGROOT
Signature Title TREASURER
Signature Date 5/29/2020

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