FORM 1023-EZ for BLEDSOE COUNTY COMMUNITY FOOD BANK

Field Data
EIN 47-2117694
Case Number EO-2019148-000386
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLEDSOE COUNTY COMMUNITY FOOD BANK
Organization’s Mailing Address P O BOX 996
City PIKEVILLE
State TN
ZIP 37367
Accounting period End 12
Primary contact name VIRGINIA M HOUSLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VIRGINIA HOUSLEY
DIRECTOR
5260 LOWER EAST VALLEY RD
DUNLAP TN 37327

Officer/Director/Trustee Two

KAREN CONN
VICE DIRECTOR
497 HARLEE VISTA RD
PIKEVILLE TN 37367

Officer/Director/Trustee Three

SUE COLVARD
TREASURER
P O BOX 145
PIKEVILLE TN 37367

Officer/Director/Trustee Four

MARY WILLIAMS
SECRETARY
364 BEAVER HILL RD
PIKEVILLE TN 37367

Officer/Director/Trustee Five

EMMA BOYNTON
BOARD MEMBER (VOTING)
P O BOX 214
PIKEVILLE TN 37367

Organization’s website WWW.BLEDSOEFOODBANK.ORG
Organization’s email BCCFB@BLEDSOE.NET
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/19/14
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name VIRGINIA HOUSLEY
Signature Title DIRECTOR
Signature Date 5/23/19
EIN 47-2117694
Case Number EO-2015289-000194
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLEDSOE COUNTY COMMUNITY FOOD BANK
Organization’s Mailing Address 3357 MAIN STREET
City PIKEVILLE
State TN
ZIP 37367
Accounting period End 12
Primary contact name VIRGINIA M HOUSLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

VIRGINIA HOUSLEY
PRESIDENT / CHAIR
5260 LOWER EAST VALLEY RD
DUNLAP TN 37327

Officer/Director/Trustee Two

SUE COLVARD
TREASURER
P O BOX 145
PIKEVILLE TN 37367

Officer/Director/Trustee Three

MARY WILLIAMS
SECRETARY
364 BEAVER HILL RD
PIKEVILLE TN 37367

Officer/Director/Trustee Four

LINDA STILES
VICE PRESIDENT / VICE CHAIR
P O BOX 838
DAYTON TN 37321

Officer/Director/Trustee Five

EMMA BOYNTON
BOARD MEMBER (VOTING)
P O BOX 234
PIKEVILLE TN 37367

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/19/2014
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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
Signature Title
Signature Date

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