Annual Report For Nonprofit Corporation (2017)

Mark Martin Arkansas Secretary of State 1401 W. Capitol, Suite 250, Little Rock, AR 72201 501-682-3409 · www.sos.arkansas.gov 2017 ANNUAL REPORT FOR NONPROFIT CORPORATION Report Due August 1st Pursuant to A.C.A. § 4-33-131 File Online Today at www.sos.arkansas.gov 1. Name of the Nonprofit Corporation: 2. Jurisdiction of incorporation (State or foreign country) under whose laws the corporation was incorporated : 3. Name of Registered Agent for Service of Process: Address for Registered Agent, MUST be a physical address in the State of Arkansas: City: E-mail (optional): 4. Address for Corporation's Principal Office: City: E-mail (optional): 5. Names of Principal Officers: State: Phone (optional): Addresses of Principal Officers: Zip: State: Phone (optional): Zip: 6. Names of Board of Directors (minimum of 3 persons): Addresses of Board of Directors: NOTE: Include any additional officers or directors on page 2, if needed. 7. Annual Report Contact Name and Address (if different than above): Address: City: 8. Is this entity registered with the IRS as an exempt organization? (optional) If yes, what type of exemption status is held? (optional) I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days. Executed this day of , 20 . State: Zip: Signature and Title of Authorized Director or Officer Printed Name and Title of Authorized Director or Officer Rev. 12/16 American LegalNet, Inc. www.FormsWorkFlow.com Mark Martin 5. Names of Principal Officers: Arkansas Secretary of State 1401 W. Capitol, Suite 250, Little Rock, AR 72201 501-682-3409 · www.sos.arkansas.gov Please list any additional Principal Officers or Board of Directors below: Addresses of Principal Officers: 6. Names of Board of Directors: Addresses of Board of Directors: American LegalNet, Inc. www.FormsWorkFlow.com Rev. 12/16