FORM 1023-EZ for KENTUCKY PERINATAL ASSOCIATION

Field Data
EIN 61-1164068
Case Number EO-2015152-000151
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KENTUCKY PERINATAL ASSOCIATION
Organization’s Mailing Address P O BOX 577
City SHELBYVILLE
State KY
ZIP 40066
Accounting period End 12
Primary contact name ZARING SULLIVAN LAW OFFICE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ERIC REYNOLDS
PRESIDENT
P O BOX 577
SHELBYVILLE KY 40066

Officer/Director/Trustee Two

SAMANTHA PORT
VICE PRESIDENT
P O BOX 577
SHELBYVILLE KY 40066

Officer/Director/Trustee Three

AMY SNELL
SECRETARY
P O BOX 577
SHELBYVILLE KY 40066

Officer/Director/Trustee Four

JOHN OBRIEN
TREASURER
P O BOX 577
SHELBYVILLE KY 40066

Officer/Director/Trustee Five

GARY WALLS
DIRECTOR
P O BOX 577
SHELBYVILLE KY 40066

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/23/1989
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
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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