FORM 1023-EZ for 3S FOR KAY FOUNDATION INC

Field Data
EIN 47-5177809
Case Number EO-2019072-000334
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name 3S FOR KAY FOUNDATION INC
Organization’s Mailing Address 54 MAPLE AVE APT 1
City HEMPSTEAD
State NY
ZIP 11550
Accounting period End 12
Primary contact name DAVID MOSES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER SMITH
PRESIDENT
54 MAPLE AVE APT1
HEMPSTEAD NY 11550

Officer/Director/Trustee Two

JUAN POLLEY
VICE PRESIDENT
54 MAPLE AVE APT1
HEMPSTEAD NY 11550

Officer/Director/Trustee Three

DAVID MOSES
TREASURER
125 SOUTH BAYVIEW AVE APT B11
FREEPORT NY 11520

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/18/15
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N40 - Sports Training Facilities, Agencies
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JENNIFER SMITH
Signature Title PRESIDENT
Signature Date 3/10/19
EIN 47-5177809
Case Number EO-2015306-000409
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name 3S FOR KAY FOUNDATION INC
Organization’s Mailing Address 54 MAPLE AVENUE APT 1
City HEMPSTEAD
State NY
ZIP 11550
Accounting period End 12
Primary contact name RENEE D CHARLES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JENNIFER SMITH
PRESIDENT
54 MAPE AVE APT 1
HEMPSTEAD NY 11550

Officer/Director/Trustee Two

JUAN POLLEY
TREASURER
110 LEONARD AVE
FREEPORT NY 11520

Officer/Director/Trustee Three

MICHELLE COLE
SECRETARY
562 ASH COURT
UNIONDALE NY 11553

Organization’s website
Organization’s email KAJUAN00@VERIZON.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/14/2015
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
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 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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