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ObjectId: 201901349349202005 - Submission: 2019-05-07
TIN: 46-1229757
Form
990EZ
Department of the Treasury
Internal Revenue Service
Short Form
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990EZ
for instructions and the latest information.
OMB No. 1545-1150
20
18
Open to Public
Inspection
A
For the 2018 calendar year, or tax year beginning
01-01-2018
, and ending
12-31-2018
B
Check if applicable:
Address change
Name change
Initial return
Final return/terminated
Amended return
Application pending
C
Name of organization
Healthy Tennessee
Number and street (or P. O. box, if mail is not delivered to street address)
4432 Curtiswood Dr
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Nashville
,
TN
37204
D Employer identification number
46-1229757
E
Telephone number
(615) 668-5659
F
Group Exemption
Number
G
Accounting Method:
Cash
Accrual
Other (specify)
H
Check
required to attach Schedule B
(Form 990, 990-EZ, or 990-PF).
I Website:
myhealthytennessee.com
J Tax-exempt status
(check only one) -
501(c)(3)
501(c)
(
)
(insert no.)
4947(a)(1)
or
527
K
Form of organization:
Corporation
Trust
Association
Other
L
Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ
...........................
$
188,500
Part
Ⅰ
Revenue, Expenses, and Changes in Net Assets or Fund Balances
(see the instructions for Part I)
Check if the organization used Schedule O to respond to any question in this Part I
.....................
1
Contributions, gifts, grants, and similar amounts received
....................
1
188,500
2
Program service revenue including government fees and contracts
...............
2
3
Membership dues and assessments
...........................
3
4
Investment income
...........................
4
5a
Gross amount from sale of assets other than inventory
.....
5a
b
Less: cost or other basis and sales expenses
.......
5b
c
Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a)
......
5c
6
Gaming and fundraising events
a
Gross income from gaming (attach Schedule G if greater than $15,000)
6a
b
Gross income from fundraising events (not including $
of contributions from fundraising events reported on line 1) (attach Schedule G if the
sum of such gross income and contributions exceeds $15,000)
..
6b
c
Less: direct expenses from gaming and fundraising events
...
6c
d
Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)
6d
7a
Gross sales of inventory, less returns and allowances
......
7a
b
Less: cost of goods sold
.............
7b
c
Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a)
.........
7c
8
Other revenue (describe in Schedule O)
..........
8
9
Total revenue.
Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8
..............
9
188,500
10
Grants and similar amounts paid (list in Schedule O)
............
10
11
Benefits paid to or for members
................
11
12
Salaries, other compensation, and employee benefits
................
12
13
Professional fees and other payments to independent contractors
............
13
51,985
14
Occupancy, rent, utilities, and maintenance
...................
14
1,650
15
Printing, publications, postage, and shipping
..............
15
4,943
16
Other expenses (describe in Schedule O)
..............
16
41,605
17
Total expenses.
Add lines 10 through 16
..............
17
100,183
18
Excess or (deficit) for the year (Subtract line 17 from line 9)
............
18
88,317
19
Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
end-of-year figure reported on prior year’s return)
............
19
185,492
20
Other changes in net assets or fund balances (explain in Schedule O)
..........
20
5,000
21
Net assets or fund balances at end of year. Combine lines 18 through 20
.......
21
278,809
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10642I
Form
990-EZ
(2018)
Page 2
Form 990-EZ (2018)
Page
2
Part
Ⅱ
Balance Sheets
(see the instructions for Part II)
Check if the organization used Schedule O to respond to any question in this Part II
.................
(A)
Beginning of year
(B)
End of year
22
Cash, savings, and investments
................
179,830
22
268,147
23
Land and buildings
....................
23
24
Other assets (describe in Schedule O)
..........
5,662
24
10,662
25
Total assets
......................
185,492
25
278,809
26
Total liabilities
(describe in Schedule O)
.............
26
27
Net assets or fund balances
(line 27 of column (B)
must
agree with line 21)
185,492
27
278,809
Part
Ⅲ
Statement of Program Service Accomplishments
(see the instructions for Part III)
Check if the organization used Schedule O to respond to any question in this Part III
.
.
Expenses
(Required for section 501(c)(3) and 501(c)(4) organizations; optional for others.)
What is the organization's primary exempt purpose?
Preventative Healthcare Awareness
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28
a central portal of basic healthcare information. Raise statewide awareness on the needfor healthcare prevention and access to care in communities throughout the state. Focus on rural communities lacking care.
(Grants $
)
If this amount includes foreign grants, check here
...
28a
29
(Grants $
)
If this amount includes foreign grants, check here
...
29a
30
(Grants $
)
If this amount includes foreign grants, check here
...
30a
31
Other program services (describe in Schedule O)
................
(Grants $
)
If this amount includes foreign grants, check here
...
31a
32 Total program service expenses
(add lines 28a through 31a)
..........
32
Part
Ⅳ
List of Officers, Directors, Trustees, and Key Employees
(list each one even if not compensated see the instructions for Part IV)
Check if the organization used Schedule O to respond to any question in this Part IV
............
(a)
Name and title
(b)
Average
hours per week
devoted to position
(c)
Reportable compensation
(Forms W-2/1099-MISC)
(if not paid, enter -0-)
(d)
Health benefits, contributions to employee benefit plans, and
deferred compensation
(e)
Estimated amount
of other compensation
Manish K Sethi
President
020.00
0
Maya Sethi
Secretary
020.00
0
Alex Jahangir
Member
005.00
0
Jesse Ehrenfeld
Member
005.00
0
Form
990-EZ
(2018)
Page 3
Form 990-EZ (2018)
Page
3
Part
Ⅴ
Other Information
(Note the Schedule A and personal benefit contract statement requirements in the
instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V
.......
Yes
No
33
Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a
detailed description of each activity in Schedule O
...................
33
No
34
Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy
of the amended documents if they reflect a change to the organization’s name. Otherwise, explain the change
on Schedule O (see instructions)
..........................
34
No
35a
Did the organization have unrelated business gross income of $1,000 or more during the year from business
activities (such as those reported on lines 2, 6a, and 7a, among others)?
............
35a
No
b
If "Yes," to line 35a, has the organization filed a Form 990-T for the year? If "No," provide
an explanation in Schedule O
35b
c
Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e)
notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III
35c
No
36
Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during
the year? If “Yes," complete applicable parts of Schedule N
................
36
No
37a
Enter amount of political expenditures, direct or indirect, as described in the instructions.
37a
b
Did the organization file
Form 1120-POL
for this year?
...................
37b
No
38a
Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee
or
were
any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?
..
38a
No
b
If “Yes," complete Schedule L, Part II and enter the total amount involved
.
38b
39
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on line 9
.......
39a
b
Gross receipts, included on line 9, for public use of club facilities
.....
39b
40a
Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911
0
; section 4912
0
; section 4955
0
b
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in any section 4958
excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that
has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes," complete Schedule L, Part I
40b
No
c
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax imposed on organization
managers or disqualified persons during the year under sections
4912, 4955, and 4958
d
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax on line 40c reimbursed
by the organization
e
All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter
transaction? If "Yes," complete Form 8886-T
................
40e
41
List the states with which a copy of this return is filed.
42a
The organization's books are in care of
Troy Brewer CPA Inc
Telephone no.
(615) 668-5659
Located at
95 White Bridge Rd Suite 207
Nashville
,
TN
ZIP + 4
37205
Yes
No
b
At any time during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
.
.
42b
No
If “Yes," enter the name of the foreign country:
See the instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR)
c
At any time during the calendar year, did the organization maintain an office outside the U.S.?
.
.
.
42c
No
If “Yes," enter the name of the foreign country:
43
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of
Form 1041 -
Check here
......
and enter the amount of tax-exempt interest received or accrued during the tax year
....
43
Yes
No
44a
Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead
of Form 990-EZ
.............................
44a
No
b
Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be completed
instead of Form 990-EZ
.............................
44b
No
c
Did the organization receive any payments for indoor tanning services during the year?
.........
44c
No
d
If "Yes," to line 44c, has the organization filed a Form 720 to report these payments?
If "No," provide an
explanation in Schedule O
............................
44d
No
45a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
.........
45a
No
45b
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of
Form 990-EZ (see instructions)
.........................
45b
No
Form
990-EZ
(2018)
Page 4
Form 990-EZ (2018)
Page
4
Yes
No
46
Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition to
candidates for public office? If “Yes," complete Schedule C, Part I.
...........
46
No
Part
Ⅵ
Section 501(c)(3) organizations only
All section 501(c)(3) organizations must answer questions 47- 49b and 52, and complete the tables for lines 50 and 51.
Check if the organization used Schedule O to respond to any question in this Part VI
..................
Yes
No
47
Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year?
If "Yes," complete Schedule C, Part II
.......................
47
No
48
Is the organization a school as described in section 170(b)(1)(A)(ii)?
If "Yes," complete Schedule E
..
48
No
49a
Did the organization make any transfers to an exempt non-charitable related organization?
......
49a
No
b
If "Yes," was the related organization a section 527 organization?
................
49b
50
Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a)
Name and title of each employee
(b)
Average
hours per week
devoted to position
(c)
Reportable compensation
(Forms W-2/1099-MISC)
(d)
Health benefits, contributions to employee benefit plans, and deferred compensation
(e)
Estimated amount of other compensation
NONE
f
Total number of other employees paid over $100,000
.............
51
Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a)
Name and business address of each independent contractor
(b)
Type of service
(c)
Compensation
NONE
d
Total number of other independent contractors each receiving over $100,000
..........
52
Did the organization complete Schedule A?
NOTE.
All section 501(c)(3) organizations must attach a
completed Schedule A
........................................
Yes
No
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
2019-05-07
Signature of officer
Date
Manish K Sethi
05092018
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
James T Brewer
Preparer's signature
Date
2019-05-07
Check
if
self-employed
PTIN
Firm's name
Troy Brewer CPA Inc
Firm's EIN
Firm's address
95 White Bridge Rd Suite 207
Nashville
,
TN
37205
Phone no.
(615) 668-5659
May the IRS discuss this return with the preparer shown above? See instructions
.........
Yes
No
Form
990-EZ
(2018)
Additional Data
Software ID:
18007340
Software Version:
19.1.1.0
Form 990-EZ, Special Condition Description:
Special Condition Description