FORM 1023-EZ for MOSSY CREEK HEALTH INITIATIVE
| Field | Data |
|---|---|
| EIN | 86-3456159 |
| Case Number | EO-2021118-000064 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | MOSSY CREEK HEALTH INITIATIVE |
| Organization’s Mailing Address | 318 W OLD ANDREW JOHNSON HWY |
| City | JEFFERSON CITY |
| State | TN |
| ZIP | 37760 |
| Accounting period End | 12 |
| Primary contact name | JAMISON PRICE |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JAMISON PRICE
PRESIDENT
2011 OVERLOOK AVE
JEFFERSON CITY TN 37760
Officer/Director/Trustee Two
KELSEY GRIFFITH
VICE PRESIDENT
1260 SWEET WILLIAMS LANE
NEW MARKET TN 37820
Officer/Director/Trustee Three
DAVID BLEVINS
SECRETARY
2004 LAKEVIEW DR
JEFFERSON CITY TN 37760
Officer/Director/Trustee Four
RHONDA BLEVINS
TREASURER
3004 LAKEVIEW DR
JEFFERSON CITY TN 37760
Officer/Director/Trustee Five
LESLEY PRICE
COMMUNICATIONS DIRECTOR
2011 OVERLOOK AVE
JEFFERSON CITY TN 37760
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/23/2021 |
| Organization Incorporation State | TN |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E01 - 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 | Yes |
| 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 | JAMISON PRICE |
| Signature Title | PRESIDENT |
| Signature Date | 4/24/2021 |
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