FORM 1023-EZ for JAMES HENRY SHAW IV FOUNDATION

Field Data
EIN 83-3073805
Case Number EO-2019038-000541
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JAMES HENRY SHAW IV FOUNDATION
Organization’s Mailing Address 611 CLARE RIDGE COURT
City FRANKLIN
State TN
ZIP 37064
Accounting period End 12
Primary contact name FLOYD LUTTRELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FLOYD LUTTRELL
PRESIDENT
611 CLARE RIDGE COURT
FRANKLIN TN 37064

Officer/Director/Trustee Two

AVA SHAW
DIRECTOR
611 CLARE RIDGE COURT
FRANKLIN TN 37064

Officer/Director/Trustee Three

JASE SHAW
DIRECTOR
611 CLARE RIDGE COURT
FRANKLIN TN 37064

Officer/Director/Trustee Four

PATRICK HALE
VICE-PRESIDENT
9427 PRUITT ROAD
CHRISTIANA TN 37037

Officer/Director/Trustee Five

DAVID UNDERWOOD
SECRETARY
2246 DOMINICK DRIVE
NOLENSVILLE TN 37135

Organization’s website
Organization’s email FCLUTTRELL@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/9/19
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G80 - Specifically Named Diseases
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 FLOYD LUTTRELL
Signature Title PRESIDENT
Signature Date 1/31/19

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