FORM 1023-EZ for KIDS BATTLE DIABETES

Field Data
EIN 47-1743275
Case Number EO-2015260-000367
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KIDS BATTLE DIABETES
Organization’s Mailing Address 3903 SPARTA PIKE
City WATERTOWN
State TN
ZIP 37184
Accounting period End 12
Primary contact name RICK MARTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RICK MARTIN
PRESIDENT
3903 SPARTA PIKE
WATERTOWN TN 37184

Officer/Director/Trustee Two

JOHN MCDEARMAN
SECRETARY
518 RIDGECREST LANE
LEBANON TN 37087

Officer/Director/Trustee Three

TERRY BURNS
OFFICER
545 RIDGECREST LANE
LEBANON TN 37087

Officer/Director/Trustee Four

SUSAN LYNN
OFFICER
388 GREEN HARBOR ROAD
OLD HICKORY TN 37138

Officer/Director/Trustee Five

TIM DIFFENDERFER
OFFICER
104 GLEN HAVEN COURT
LEBANON TN 37087

Organization’s website
Organization’s email BRANT54@HOTMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/4/2014
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H80 - Specifically Named Diseases Research
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
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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