FORM 1023-EZ for MT MITCHELL COMMUNITIY FND

Field Data
EIN 87-2285811
Case Number EO-2021237-000243
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MT MITCHELL COMMUNITIY FND
Organization’s Mailing Address 286 FAIRWAY LOOP
City BURNSVILLE
State NC
ZIP 28714
Accounting period End 12
Primary contact name RICHARD H ADAMS JR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HELEN BLALOCK
DIRECTOR SECRETARY
125 TOWNHOUSE DRIVE
BURNSVILLE NC 28714

Officer/Director/Trustee Two

DONALD WISCH
DIRECTOR VICE PRESIDENT
286 FAIRWAY LOOP
BURNSVILLE NC 28714

Officer/Director/Trustee Three

HOLLIS DOWNS
DIRECTOR
69 BIG RIDGE COURT
BURNSVILLE NC 28714

Officer/Director/Trustee Four

LARRY THOMPSON
DIRECTOR
740 WINTERSTAR LOOP
BURNSVILLE NC 28714

Officer/Director/Trustee Five

RICHARD ADAMS
PRESIDENT DIRECTOR
57 SIGNATURE LANE
BURNSVILLE NC 28714

Organization’s website
Organization’s email DADAMS1439@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/13/2021
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 RICHARD ADAMS
Signature Title PRESIDENT DIRECTOR
Signature Date 8/23/2021

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