FORM 1023-EZ for THE JOHNSON AUDIOLOGY HEARING FOUNDATION

Field Data
EIN 84-3010938
Case Number EO-2019259-000681
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE JOHNSON AUDIOLOGY HEARING FOUNDATION
Organization’s Mailing Address 5617 HIGHWAY 153 SUITE 203
City HIXSON
State TN
ZIP 37343
Accounting period End 12
Primary contact name JAN HOLLINGSWORTH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MEGAN JOHNSON
PRESIDENT
5617 HIGHWAY 153 STE 203
HIXSON TN 37343

Officer/Director/Trustee Two

WHITNEY SMITH
VICE PRESIDENT
5617 HIGHWAY 153 STE 203
HIXSON TN 37343

Officer/Director/Trustee Three

JAN HOLLINGSWORTH
SECRETARY
5617 HIGHWAY 153
HIXSON TN 37343

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/11/19
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
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 JAN HOLLINGSWORTH
Signature Title SECRETARY
Signature Date 9/11/19

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