FORM 1023-EZ for BACK CREEK GROUP

Field Data
EIN 45-4407286
Case Number EO-2016236-000143
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BACK CREEK GROUP
Organization’s Mailing Address 304 MONTLAKE RD
City SODDY DAISY
State TN
ZIP 37379
Accounting period End 12
Primary contact name CHARLES R TERRY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT ELMORE
PRESIDENT
112 ROLLING HILLS DR
HIXSON TN 37343

Officer/Director/Trustee Two

CHARLES TERRY
SECRETARY
304 MONTLAKE RD
SODDY DAISY TN 37379

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/31/2012
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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