FORM 1023-EZ for RENEW CLINIC

Field Data
EIN 84-2343852
Case Number EO-2019193-000143
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name RENEW CLINIC
Organization’s Mailing Address PO BOX 24340
City KNOXVILLE
State TN
ZIP 37933-2340
Accounting period End 12
Primary contact name HENRY BIEBER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HENRY BIEBER
PRESIDENT
9900 WHISPERING WIND LANE
KNOXVILLE TN 37922-5747

Officer/Director/Trustee Two

JIM COFFIELD
DIRECTOR
12915 KINGSTON PIKE
KNOXVILLE TN 37922-5113

Officer/Director/Trustee Three

SETH HAMMOND
DIRECTOR
12915 KINGSTON PIKE
KNOXVILLE TN 37922-5113

Officer/Director/Trustee Four

CORY MAYFIELD
DIRECTOR
PO BOX 24340
KNOXVILLE TN 37933-2340

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/30/19
Organization Incorporation State TN
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: Yes
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 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 HENRY BIEBER
Signature Title PRESIDENT
Signature Date 7/10/19

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