FORM 1023-EZ for AVERY COUNTY JAM

Field Data
EIN 84-3032417
Case Number EO-2019274-000259
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AVERY COUNTY JAM
Organization’s Mailing Address 197 CAMELI DRIVE
City BANNER ELK
State NC
ZIP 28604
Accounting period End 12
Primary contact name TIM CUMMINGS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FAITH SHAFFNER
COORDINATOR
197 CAMELI DRIVE
BANNER ELK NC 28604

Officer/Director/Trustee Two

BRUCE ROESNER
TREASURE
197 CAMELOT DRIVE
BANNER ELK NC 28604

Officer/Director/Trustee Three

NICOLE LAMOTTE
BOARD OF DIRECTORS
224 OLD TURNPIKE ROAD EAST
BANNER ELK NC 28604

Officer/Director/Trustee Four

DAN GREENE
BOARD OF DIRECTORS
PO BOX 342
PINEOLA NC 28604

Officer/Director/Trustee Five

TIMOTHY CUMMINGS
BOARD OF DIRECTORS
504 LAUREL LANE
NEWLAND NC 28657

Organization’s website
Organization’s email SHAFFNERFM@MSN.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/1/19
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N11 - Single Organization Support
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 Yes
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 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 TIMOTHY CUMMINGS
Signature Title BOARD OF DIRECTORS
Signature Date 9/29/19

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