FORM 1023-EZ for THREE LAKES COMMUNITIES THAT CARE

Field Data
EIN 47-3021571
Case Number EO-2015175-000183
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THREE LAKES COMMUNITIES THAT CARE
Organization’s Mailing Address PO BOX 375
City ROSCOMMON
State MI
ZIP 48653
Accounting period End 8
Primary contact name EMILY BARBER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHELLEY HUBBARD
EXECUTIVE DIRECTOR
MARGARITHE BLVD
GRAYLING MI 48973

Officer/Director/Trustee Two

EMILY BARBER
SECRETARY/CHAIR/ASSISTANT
2160 CONTOUR DRIVE
ROSCOMMON MI 48653

Officer/Director/Trustee Three

CHRIS TAPPAN
BOARD MEMBER
225 PAT DRIVE
MIO MI 48647

Officer/Director/Trustee Four

AMY COULTER
BOARD MEMBER
JAMES SQUARE
ROSCOMMON MI 48653

Officer/Director/Trustee Five

SHAD FISH
BOARD MEMBER
6001 WEST HOUGHTON LAKE DRIVE
HOUGHTON LAKE MI 48651

Organization’s website
Organization’s email 3LAKESCTCARE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/26/2015
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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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