FORM 1023-EZ for JESSAMINE COUNTY HOMELESS COALITIONINC

Field Data
EIN 81-2578809
Case Number EO-2016133-000171
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JESSAMINE COUNTY HOMELESS COALITIONINC
Organization’s Mailing Address 218 EAST MAPLE STREET
City NICHOLASVILLE
State KY
ZIP 40356
Accounting period End 12
Primary contact name JOHNNY TEMPLN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT GULLETTE
DIRECTOR
125 S MAIN STREET
NICHOLASVILLE KY 40356

Officer/Director/Trustee Two

AMY CLOUD
DIRECTOR
208 THOMPSON ROAD
LANCASTER KY 40444

Officer/Director/Trustee Three

JOHNNY TEMPLIN
DIRECTOR
106 ELKCHESTER CIRCLE
NICHOLASVILLE KY 40356

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/26/2016
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
Organization’s purpose Charitable: Yes
Religious: No
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 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
Signature Title
Signature Date

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