FORM 1023-EZ for CAPVA INC

Field Data
EIN 83-3439846
Case Number EO-2020052-000215
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CAPVA INC
Organization’s Mailing Address 206 BENNETT STREET
City MORRILTON
State AR
ZIP 72110
Accounting period End 12
Primary contact name JENNIFER DEGROOT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER DEGROOT
DIRECTOR
206 BENNETT STREET
MORRILTON AR 72110

Officer/Director/Trustee Two

MICHAEL CHILDRESS
DIRECTOR
206 BENNETT STREET
MORRILTON AR 72110

Organization’s website WWW.CAPVA.ORG
Organization’s email J.DEGROOT@CAPVA.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/5/2019
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A20 - Arts, Cultural Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 JENNIFER DEGROOT
Signature Title DIRECTOR
Signature Date 2/19/2020

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