FORM 1023-EZ for COVERED

Field Data
EIN 81-3049581
Case Number EO-2016193-000601
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COVERED
Organization’s Mailing Address 7429 WINSTON COVE
City WALLS
State MS
ZIP 38680
Accounting period End 6
Primary contact name TONJA JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TONJA JOHNSON
PRESIDENT
7429 WINSTON COVE
WALLS MS 38680

Officer/Director/Trustee Two

LATONYA SMITH
VICE PRESIDENT
5905 AIRWAYS BLVD APT308
SOUTHAVEN MS 38671

Officer/Director/Trustee Three

CAJAVIA WOOTEN
SECRETARY
4335 BLUFF RD
COLDWATER MS 38618

Officer/Director/Trustee Four

MISHA HEARNS
TREASURER
3832 FORREST PARK COVE
HORNLAKE MS 38637

Officer/Director/Trustee Five

LAVONDA DUKES
DIRECTOR
290 MAYSE RD
BYHALIA MS 38611

Organization’s website
Organization’s email TEAMJOHNSON2014@ICLOUD.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/22/2016
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P30 - Children's, Youth Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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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