FORM 1023-EZ for SUMNER COUNTY HEALTH COMMITTEE INC

Field Data
EIN 83-4058686
Case Number EO-2019186-000269
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SUMNER COUNTY HEALTH COMMITTEE INC
Organization’s Mailing Address 355 NORTH BELVEDERE DRIVE
City GALLATIN
State TN
ZIP 37066
Accounting period End 12
Primary contact name DUSTIN LITTLEPAGE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HAL HENDRICKS
DIRECTOR
355 NORTH BELVEDERE DRIVE ROOM 102
GALLATIN TN 37066

Officer/Director/Trustee Two

ASHLEY BERRY
PRESIDENT
115 GOLFERS CIRCLE
PORTLAND TN 31478

Officer/Director/Trustee Three

JAIME MUNCY
VICE PRESIDENT
355 NORTH BELVEDERE DRIVE ROOM 102
GALLATIN TN 37066

Officer/Director/Trustee Four

LUGENE SLOAN
SECRETARY
517 REDSTONE DRIVE
GALLATIN TN 37066

Officer/Director/Trustee Five

JERRY KLEIN
TREASURER
1628 FOXLAND BLVD
GALLATIN TN 37066

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/25/19
Organization Incorporation State TN
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: No
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 HAL HENDRICKS
Signature Title DIRECTOR
Signature Date 7/3/19

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