FORM 1023-EZ for ZYL OPTIX CLINIC INC

Field Data
EIN 84-4593613
Case Number EO-2020049-000336
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ZYL OPTIX CLINIC INC
Organization’s Mailing Address 707 ASPEN AVENUE
City SHELLEY
State ID
ZIP 83274-1464
Accounting period End 12
Primary contact name CHRISTOPHER J CAPRON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTOPHER CAPRON
DIRECTOR
707 ASPEN AVE
SHELLEY ID 83274-1464

Officer/Director/Trustee Two

ERIN CAPRON
DIRECTOR
707 ASPEN AVE
SHELLEY ID 83274-1464

Officer/Director/Trustee Three

KREYTON JACKSON
DIRECTOR
3557 EAST 630 NORTH
MENAN ID 83434

Officer/Director/Trustee Four

KENDALL WILLDEN
DIRECTOR
9635 TUSTIN
IDAHO FALLS ID 83401

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/31/2020
Organization Incorporation State ID
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G90 - Medical Disciplines
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 Yes
Donation of funds Yes
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 CHRISTOPHER CAPRON
Signature Title DIRECTOR
Signature Date 2/13/2020

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