FORM 1023-EZ for KCNA2 EPILEPSY INC

Field Data
EIN 86-1894240
Case Number EO-2021092-000353
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KCNA2 EPILEPSY INC
Organization’s Mailing Address 8137 BISHOPS COURT
City BROADVIEW HEIGHTS
State OH
ZIP 44147
Accounting period End 12
Primary contact name MICHAEL URSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NANCY MUSARRA
PRESIDENT, TREASURER, DIRECTOR
8137 BISHOPS COURT
BROADVIEW HEIGHTS OH 44147

Officer/Director/Trustee Two

ERIN LIVINGSTON
SECRETARY, DIRECTOR
9662 HIGHLAND DRIVE
BRECKSVILLE OH 44141

Officer/Director/Trustee Three

JESSICA WISH
DIRECTOR
6408 DORA BLVD
INDEPENDENCE OH 44131

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/2/2020
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G54 - Epilepsy
Organization’s purpose Charitable: No
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 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 NANCY MUSARRA
Signature Title PRESIDENT, TREASURER, DIRECTOR
Signature Date 2/22/2021

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