FORM 1023-EZ for COLUMBIA LIONS CLUB COMMUNITY FOUNDATION

Field Data
EIN 81-1218119
Case Number EO-2016047-000182
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COLUMBIA LIONS CLUB COMMUNITY FOUNDATION
Organization’s Mailing Address PO BOX 694
City COLUMBIA
State TN
ZIP 38402
Accounting period End 6
Primary contact name JOHN THYEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GEORGIA DAVIS
PRESIDENT
1958 BRYANT RD
COLUMBIA TN 38401

Officer/Director/Trustee Two

MARY DEHAVEN
TREASURER
200 SUNNYSIDE LANE
COLUMBIA TN 38401

Officer/Director/Trustee Three

JOHN THYEN
VICE PRESIDENT
1012 CLAREMONT DR
COLUMBIA TN 38401

Officer/Director/Trustee Four

BETTY JEAN GANDEE
SECRETARY
4400 TROUSDALE LN
COLUMBIA TN 38401

Officer/Director/Trustee Five

JOHN ALLEN
DIRECTOR
900 SCHOOL RD
COLUMBIA TN 38401

Organization’s website COLUMBIALIONSCLUB.COM
Organization’s email MAURYCOUNTYLIONSCOLUMBIA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/6/2015
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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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