FORM 1023-EZ for VETERANS INTEGRATED PROVIDER INC

Field Data
EIN 47-2301281
Case Number EO-2014328-000172
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name VETERANS INTEGRATED PROVIDER INC
Organization’s Mailing Address 19 LITTLETON WAY
City MUNFORD
State TN
ZIP 38058
Accounting period End 12
Primary contact name CORNELL GALLOWAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOHN CAMERON
PRESIDENT, DIRECTOR
3870 RUSSELL CT
BARTLETT TN 38135

Officer/Director/Trustee Two

AMANDA SULLIVAN
SECRETARY, DIRECTOR
19 LITTLETON WAY
MUNFORD TN 38058

Officer/Director/Trustee Three

SHIRLEEN CLARK
TREASURER, DIRECTOR
99 WHARTH LN
MUNFORD TN 38058

Officer/Director/Trustee Four

CORNELL GALLOWAY
DIRECTOR
19 LITTLETON WAY
MUNFORD TN 38058

Officer/Director/Trustee Five

JAMES KENT
DIRECTOR
170 ROBERT L ELLIS DR
MUNFORD TN 38058

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/3/2014
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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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