FORM 1023-EZ for COMMUNITY ACTION PLACE INC

Field Data
EIN 47-5193214
Case Number EO-2016051-000102
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COMMUNITY ACTION PLACE INC
Organization’s Mailing Address 502 N HORN STREET
City WEST FRANKFORT
State IL
ZIP 62896-1847
Accounting period End 12
Primary contact name SCOTT FLETCHER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SCOTT FLETCHER
CHAIR
502 N HORN ST
WEST FRANKFORT IL 62896-1847

Officer/Director/Trustee Two

MARVINA HALTON
VICE CHAIR
2310 HOLBROOK AVE
CAIRO IL 62914

Officer/Director/Trustee Three

DINA TIMMONS
SECRETARY
305 W ANDREW SPRINGS RD
CULP IL 62921

Officer/Director/Trustee Four

JOSEPH FLETCHER
TREASURER
502 N HORN ST
WEST FRANKFORT IL 62896-1847

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/4/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T31 - Community Foundations
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 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
Signature Title
Signature Date

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