FORM 1023-EZ for MT EMORY VISION CENTER

Field Data
EIN 83-1366830
Case Number EO-2018212-000123
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MT EMORY VISION CENTER
Organization’s Mailing Address 426 S CHURCH ST
City JACKSONVILLE
State IL
ZIP 62650
Accounting period End 12
Primary contact name LINDA BEERS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID STEWART
PRES
5212 E MELWOOD CT
DECATUR IL 62520

Officer/Director/Trustee Two

JOHNNY NICHOLS
VP
1314 TENDICK
JACKSONVILLE IL 62650

Officer/Director/Trustee Three

VANESSA TYUS
DIRECTOR
702 S CHURCH ST
JACKSONVILLE IL 62650

Officer/Director/Trustee Four

EARNESTINE BERKLEY
TREAS
3 GREENBRIAR DR
JACKSONVILLE IL 62650

Officer/Director/Trustee Five

REBECCA GRAVES
SEC
P O BOXZ 403
JACKSONVILLE IL 62650

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/25/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
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 DAVID STEWART
Signature Title PRES
Signature Date 7/27/18

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