FORM 1023-EZ for HUMPHREYS HOMELESS COALITION

Field Data
EIN 83-3692446
Case Number EO-2019200-000361
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HUMPHREYS HOMELESS COALITION
Organization’s Mailing Address 208 W MAIN ST
City WAVERLY
State TN
ZIP 37185
Accounting period End 12
Primary contact name JANICE RUDOLPH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GRANT GILLESPIE
CHAIRMAN
103 E MAIN ST
WAVERLY TN 37185

Officer/Director/Trustee Two

JAN DAVIS
VICE CHAIRMAN
102 THOMPSON ST ROOM 3
WAVERLY TN 37185

Officer/Director/Trustee Three

JANICE RUDOLPH
SECRETARY
691 E MAIN ST
WAVERLY TN 37185

Officer/Director/Trustee Four

LISA KIMMONS
TREASURER
208 W MAIN ST
WAVERLY TN 37185

Organization’s website
Organization’s email HUMPHREYSHOMELESSCOALITION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/20/19
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
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 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 JANICE RUDOLPH
Signature Title SECRETARY
Signature Date 7/17/19

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