FORM 1023-EZ for TENNESSEE VALLEY MEDIATION ASSOCIATION

Field Data
EIN 81-1342733
Case Number EO-2016043-000106
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TENNESSEE VALLEY MEDIATION ASSOCIATION
Organization’s Mailing Address 1504 KENTON COURT
City ANTIOCH
State TN
ZIP 37013
Accounting period End 12
Primary contact name ROBIN BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRIS BEAVERS
PRESIDENT
2125 MIDDLEBROOK PIKE
KNOXVILLE TN 37921

Officer/Director/Trustee Two

FRAN CLEMMONS
VICE PRESIDENT
332 JAVA WAY
KNOXVILLE TN 37923

Officer/Director/Trustee Three

ADONIA PHILLIPS
SECRETARY
PO BOX 648
SEYMOUR TN 37865

Officer/Director/Trustee Four

ROBIN BROWN
TREASURER
1504 KENTON COURT
ANTIOCH TN 37013

Organization’s website TNMEDIATORS.COM
Organization’s email RBROWN2456@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/7/2002
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: No
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
Signature Title
Signature Date

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