FORM 1023-EZ for KHAMSA 3D

Field Data
EIN 83-3342714
Case Number EO-2019070-000329
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KHAMSA 3D
Organization’s Mailing Address 681 PARKBLUFF WAY
City LEWIS CENTER
State OH
ZIP 43035
Accounting period End 12
Primary contact name ERICA NASSAR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HAMZA BELASRI
PRESIDENT
681 PARKBLUFF WAY
LEWIS CENTER OH 43035-9593

Officer/Director/Trustee Two

ERICA NASSAR
SECRETARY
77 CHENANGO DR
POWELL OH 43065-8664

Officer/Director/Trustee Three

ANDREW JACKSON
TREASURER
5873 RATIFICATION DR
GALLOWAY OH 43119-8266

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/28/19
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ERICA NASSAR
Signature Title SECRETARY
Signature Date 3/8/19

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