FORM 1023-EZ for HOUSE OF OMEGA

Field Data
EIN 47-3868927
Case Number EO-2016043-000116
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOUSE OF OMEGA
Organization’s Mailing Address 1625 CATALPA STREET
City LOUISVILLE
State KY
ZIP 40211
Accounting period End 12
Primary contact name EDDIE CRUTCHER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KEVIN WILSON
VICE PRESIDENT
9415 STONELANDING PLACE
LOUSIVILLE KY 40272

Officer/Director/Trustee Two

EDDIE CRUTCHER
PRESIDENT
11615 TAZWELL DRIVE
LOUSIVILLE KY 40245

Officer/Director/Trustee Three

ROBERT WILSON
TREASURE
2608 OREGON AVE
LOUISVILLE KY 40210

Officer/Director/Trustee Four

AYREIST BIZOR
TREASURE
4711 LACEY COURT
LOUSIVILLE KY 40218

Officer/Director/Trustee Five

WHITNEY CRUTCHER
SECRETARY
1718 MAGAZINE STREET
LOUISVILLE KY 40203

Organization’s website WWW.HOUSEOFOMEGA.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/25/2015
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P73 - Group Home (Long Term)
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
Signature Title
Signature Date

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