FORM 1023-EZ for THE KELLY FAMILY MEMORIAL FUND

Field Data
EIN 81-1673994
Case Number EO-2016088-000633
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE KELLY FAMILY MEMORIAL FUND
Organization’s Mailing Address 2935 KENT ROAD EAST
City WANTAGH
State NY
ZIP 11793
Accounting period End 12
Primary contact name SIOBHAN CASEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SIOBHAN CASEY
DIRECTOR
2935 KENT ROAD EAST
WANTAGH NY 11793

Officer/Director/Trustee Two

CHRISTINE HINRICHS
DIRECTOR
80 WILLOW AVENUE
ISLIP NY 11751

Officer/Director/Trustee Three

MARTIN KELLY
DIRECTOR
14 HILLVIEW COURT
COMMACK NY 11725

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/2/2016
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B12 - Fund Raising and/or Fund Distribution
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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