FORM 1023-EZ for MEMPHIS SHELBY COUNTY LEAD SAFE COLLABORATIVE INC

Field Data
EIN 82-4606509
Case Number EO-2018064-000157
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MEMPHIS SHELBY COUNTY LEAD SAFE COLLABORATIVE INC
Organization’s Mailing Address 1109 MISSISSIPPI BLVD
City MEMPHIS
State TN
ZIP 38126-6605
Accounting period End 6
Primary contact name CHET KIBBLE SR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHET KIBBLE SR
PRESIDENT
1109 MISSISSIPPI BLVD
MEMPHIS TN 38126-6605

Officer/Director/Trustee Two

ANNA RICHEY
SECRETARY
1109 MISSISSIPPI BLVD
MEMPHIS TN 38126-6605

Officer/Director/Trustee Three

CHET KIBBLE JR
TREASURER
1109 MISSISSIPPI BLVD
MEMPHIS TN 38126-6605

Organization’s website
Organization’s email CHETNSHERRY@BELLSOUTH.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/28/18
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
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 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 CHET KIBBLE SR
Signature Title PRESIDENT
Signature Date 3/1/18

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