FORM 1023-EZ for BOARD OF GOVERNORS OF THE SHELBYVILLE COMMUNITY SOUP KITCHEN

Field Data
EIN 81-5425385
Case Number EO-2017072-000295
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BOARD OF GOVERNORS OF THE SHELBYVILLE COMMUNITY SOUP KITCHEN
Organization’s Mailing Address 122 PUBLIC SQUARE NORTH
City SHELBYVILLE
State TN
ZIP 37160-3934
Accounting period End 12
Primary contact name LARRY L THEIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LANITA MONROE
PRESIDENT
122 PUBLIC SQUARE NORTH
SHELBVYILLE TN 37160-3934

Officer/Director/Trustee Two

RON DEWITT
VICE PRESIDENT
101 HONEYSUCKLE LA
SHELBYVILLE TN 37160-7384

Officer/Director/Trustee Three

LARRY L THEIS
SECRETARY
122 PUBLIC SQUARE NORTH
SHELBYVILLE TN 37160-3934

Officer/Director/Trustee Four

KYLE HARRIS
TREASURER
309 MADISON ST
SHELBYVILLE TN 37160-3336

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/21/2017
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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 Yes
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
Signature Title
Signature Date

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