FORM 1023-EZ for BLOUNTVILLE COMMUNITY DEVELOPMENT CORPORATION

Field Data
EIN 84-3010446
Case Number EO-2019259-000618
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLOUNTVILLE COMMUNITY DEVELOPMENT CORPORATION
Organization’s Mailing Address 3411 HIGHWAY 126 ST 206
City BLOUNTVILLE
State TN
ZIP 37617-4565
Accounting period End 12
Primary contact name PHIL KETRON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PHIL KETRON
PRESIDENT
PO BOX 3192
BLOUNTVILLE TN 37617

Officer/Director/Trustee Two

HEATHER DUBY
SECRETARY
1655 BLOUNTVILLE BLVD
BLOUNTVILLE TN 37617

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/29/16
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
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 PHIL KETRON
Signature Title PRESIDENT
Signature Date 9/11/19

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