FORM 1023-EZ for KEVINS MISSION KITCHEN INC

Field Data
EIN 83-3422611
Case Number EO-2019039-000493
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KEVINS MISSION KITCHEN INC
Organization’s Mailing Address 15176 SCOTTSDALE XING
City CHOCTAW
State OK
ZIP 73020
Accounting period End 12
Primary contact name CONNE DEMENT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CONNE DEMENT
CHIEF DIRECTOR, PRESIDENT
15176 SCOTTSDALE XING
CHOCTAW OK 73020

Officer/Director/Trustee Two

SONJA SIMPSON
DIRECTOR
1375 NORTHRIDGE DR
BOUNTIFUL UT 84010

Officer/Director/Trustee Three

TOM VALENTINE
DIRECTOR
4109 ADELPHI LANE
AUSTIN TX 78727

Officer/Director/Trustee Four

GEORGE MAIER
VOTING BOARD MEMBER
2503 DEER VALLEY DR
SHAWNEE OK 74804

Officer/Director/Trustee Five

JESSICA TAUFER
VOTING BOARD MEMBER
1277 S 910 W
LEHI UT 84043

Organization’s website
Organization’s email KEVINSMISSIONKITCHEN@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/9/19
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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 CONNE DEMENT
Signature Title CHIEF DIRECTOR, PRESIDENT
Signature Date 2/6/19

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