FORM 1023-EZ for LAUDERDALE COMMUNITY HEALTHCARE ASSOCIATION

Field Data
EIN 84-4926333
Case Number EO-2020125-000508
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAUDERDALE COMMUNITY HEALTHCARE ASSOCIATION
Organization’s Mailing Address 1399 CONNER WHITEFIELD ROAD
City RIPLEY
State TN
ZIP 38063-7091
Accounting period End 12
Primary contact name WILLIAM WOOTEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM JARRETT
DIRECTOR
1399 CONNER WHITEFELD ROAD
RIPLEY TN 38063-7091

Officer/Director/Trustee Two

MICHAEL ENOCH
DIRECTOR
101 MARVIN DRIVE
RIPLEY TN 38063-7365

Officer/Director/Trustee Three

BARRY BATES
DIRECTOR
134 WESTWOOD CIRCLE
RIPLEY TN 38063-1128

Organization’s website
Organization’s email WILLIAM@WOOTENLAWOFFICE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/28/2020
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 Yes
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 WILLIAM JARRETT
Signature Title DIRECTOR
Signature Date 5/1/2020

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