FORM 1023-EZ for FALLEN HEROES FAMILY CAMP INC

Field Data
EIN 46-1324058
Case Number EO-2015275-000221
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FALLEN HEROES FAMILY CAMP INC
Organization’s Mailing Address 3220 LIPSCOMB ROAD
City SPRINGFIELD
State TN
ZIP 37172-5668
Accounting period End 12
Primary contact name HAROLD P COFFIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MICHAEL GUSTAFSON
PRESIDENT
19409 N 2600
DENNISON IL 62423

Officer/Director/Trustee Two

HAROLD COFFIN
SECTY/TREASURER DIRECTOR
3938 W HEMLOCK AVE
VISALIA CA 93277-7023

Officer/Director/Trustee Three

TOM DAVIS
DIRECTOR - CHAIRMAN OF THE BOARD
108 HARPETH HILLS DRIVE
FRANKLIN TN 37069

Officer/Director/Trustee Four

GINA TEETER
DIRECTOR
3934 HAMPTON STATION ROAD
CLARKSVILLE TN 37040

Officer/Director/Trustee Five

CHE MOCK
DIRECTOR
1411A HAWKINS STREET
NASHVILLE TN 37203

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/10/2011
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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