FORM 1023-EZ for EGBE COMMUNITY HEALTH OUTREADH

Field Data
EIN 47-4476165
Case Number EO-2015197-000295
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EGBE COMMUNITY HEALTH OUTREADH
Organization’s Mailing Address 704 EAST WATAUGA AVENUE
City JOHNSON CITY
State TN
ZIP 37601
Accounting period End 12
Primary contact name MICHAEL STICE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TRACY GOEN
PRESIDENT / DIRECTOR
704 EAST WATAUGA AVENUE
JOHNSON CITY TN 37601

Officer/Director/Trustee Two

MICHAEL FOSTER
SEC / TREAS / DIRECTOR
704 EAST WATAUGA AVENUE
JOHNSON CITY TN 37601

Officer/Director/Trustee Three

DEANNA IRICK
DIRECTOR
704 EAST WATAUGA AVENUE
JOHNSON CITY TN 37601

Officer/Director/Trustee Four

MATTHEW WINEMAN
DIRECTOR
704 EAST WATAUGA AVENUE
JOHNSON CITY TN 37601

Officer/Director/Trustee Five

LEIGH ANN RIPPETOE
DIRECTOR
704 EAST WATAUGA AVENUE
JOHNSON CITY TN 37601

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/26/2015
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q33 - International Relief
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 Yes
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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