FORM 1023-EZ for A SHEPARDS HOME

Field Data
EIN 81-2946110
Case Number EO-2016169-000177
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name A SHEPARDS HOME
Organization’s Mailing Address 720 STEEPLECHASE DRIVE
City LEBANON
State TN
ZIP 37090-7503
Accounting period End 12
Primary contact name MONICA DUNNAGAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MONICA DUNNAGAN
PRESIDENT
720 STEEPLECHASE DRIVE
LEBANON TN 37090-7503

Officer/Director/Trustee Two

JACQUELINE KNIGHT
VICE PRESIDENT TREASURER
998 BONELLIS LANE
CLARKSVILLE TN 37040-1418

Officer/Director/Trustee Three

MARIA LUCHSINGER
SECRETARY
PO BOX 12236
EVERETT WA 98206

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/13/2016
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E91 - Nursing, Convalescent Facilities
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 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
Signature Title
Signature Date

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