FORM 1023-EZ for THE WELL OF DYERSBURG

Field Data
EIN 81-1354141
Case Number EO-2017031-000209
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE WELL OF DYERSBURG
Organization’s Mailing Address POST OFFICE BOX 1046
City DYERSBURG
State TN
ZIP 38025-1046
Accounting period End 2
Primary contact name REV CAROLYN SMITH GOINGS PHD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DIANE MALLARD
TREASURER/CLERK/ELDER
198 WALNUT LANE EXT
DYERSBURG TN 38024-6527

Officer/Director/Trustee Two

CAROLYN SMITH GOINGS
SENIOR PASTOR/PRESIDENT
719 N SAMPSON AVE
DYERSBURG TN 38024-6527

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/10/2016
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X21 - Protestant
Organization’s purpose Charitable: No
Religious: Yes
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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