FORM 1023-EZ for KHUSI HONA INC

Field Data
EIN 46-4820577
Case Number EO-2014275-000425
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KHUSI HONA INC
Organization’s Mailing Address 16312 ARMSTRONG PLACE
City TAMPA
State FL
ZIP 33647
Accounting period End 12
Primary contact name DR FRANK CIMINO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MATTHEW VAN ROOYEN
PRESIDENT
16312 ARMSTRONG PL
TAMPA FL 33647

Officer/Director/Trustee Two

GORDON PENNINGTON
DIRECTOR
160 WEST 77TH ST 7TH FLOOR
NEW YORK NY 10024

Officer/Director/Trustee Three

DAVID SCHMID
DIRECTOR
4 OLD ORCHARD WAY
TOLLAND CT 06084

Officer/Director/Trustee Four

LEON VAN ROOYEN
DIRECTOR
16312 ARMSTRONG PL
TAMPA FL 33647

Officer/Director/Trustee Five

BRAD VAN ROOYEN
DIRECTOR
18902 DEQUESENE DR
TAMPA FL 33647

Organization’s website WWW.KHUSIHONA.ORG
Organization’s email MATTHEW@KHUSIHONA.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/26/2014
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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 No
Conducting Activities Outside of United States Yes
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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