FORM 1023-EZ for COALESCE SOCIAL SERVICES INC

Field Data
EIN 86-2695331
Case Number EO-2021280-000232
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COALESCE SOCIAL SERVICES INC
Organization’s Mailing Address PO BOX 112
City BAXTER
State TN
ZIP 38544
Accounting period End 12
Primary contact name KATHRYN DUBRAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATHRYN DUBRAY
PRESIDENT & DIRECTOR
1016 FAWN DR
COOKEVILLE TN 38501

Officer/Director/Trustee Two

PATRICK MCCLELLAN
TREASURER&SECRETARY&DIRE
PO BOX 112
BAXTER TN 38544

Officer/Director/Trustee Three

FRANK LANNOM
MEMBER
1040 FAWN DRIVE
COOKEVILLE TN 38501

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/11/2021
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P85 - Homeless Persons Centers, Services
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 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 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 KATHRYN DUBRAY
Signature Title PRESIDENT & DIRECTOR
Signature Date 10/5/2021

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