FORM 1023-EZ for KERBYSTRONG

Field Data
EIN 47-3841251
Case Number EO-2015318-000012
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KERBYSTRONG
Organization’s Mailing Address 120 S WALL ST
City MACON
State IL
ZIP 62544
Accounting period End 12
Primary contact name NIKKI DAMERY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHELLIE DAMERY
EXECUTIVE DIRECTOR
120 S WALL ST
MACON IL 62544

Officer/Director/Trustee Two

BLAKE DAMERY
PRESIDENT
120 S WALL ST
MACON IL 62544

Officer/Director/Trustee Three

BRIAN HAYES
VICE PRESIDENT
355 E COOK
MACON IL 62544

Officer/Director/Trustee Four

MARYANN ALBERS
SECRETARY
9495 W ELWIN RD
BLUE MOUND IL 62513

Organization’s website WWW.KERBYSTRONG.COM
Organization’s email NIKKI@KERBYSTRONG.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/27/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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 Yes
One Third Support Gifts No
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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