FORM 1023-EZ for LEVEE STREET CLINIC INC

Field Data
EIN 64-0586284
Case Number EO-2016243-000076
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LEVEE STREET CLINIC INC
Organization’s Mailing Address POST OFFICE BOX 98
City ROSEDALE
State MS
ZIP 38769
Accounting period End 6
Primary contact name ELIZABETH C LEWIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT CRUMP
PRESIDENT
POST OFFICE BOX 547
ROSEDALE MS 38769

Officer/Director/Trustee Two

ELIZABETH LEWIS
SEC/TREASURER
POST OFFICE BOX 98
ROSEDALE MS 38769

Officer/Director/Trustee Three

RICHARD THOMAS
DIRECTOR
POST OFFICE BOX 56
BEULAH MS 38726

Officer/Director/Trustee Four

JOE BARNES
DIRECTOR
POST OFFICE BOX 549
ROSEDALE MS 38769

Officer/Director/Trustee Five

ULYSSES THOMAS
DIRECTOR
206 BUSH ROAD
ROSEDALE MS 38769

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/4/1976
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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