FORM 1023-EZ for TRI-COUNTY KIDNEY CARE FOUNDATION

Field Data
EIN 85-0558643
Case Number EO-2020092-000182
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TRI-COUNTY KIDNEY CARE FOUNDATION
Organization’s Mailing Address 2205 N LIMESTONE ST
City SPRINGFIELD
State OH
ZIP 45503
Accounting period End 12
Primary contact name CHRISTOPHER M HAMMOND
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AHSAN ULLAH
DIRECTOR PRESIDENT
3755 HURST RD
URBANA OH 43078

Officer/Director/Trustee Two

SANJU VARGHESE
DIRECTOR SECRETARY
824 OGLETHORPE CT
DAYTON OH 45458

Officer/Director/Trustee Three

BRANDY WHEALDON
DIRECTOR TREASURER
1083 HARTFORD LN
LONDON OH 43014

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/24/2020
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G44 - Kidney Disease
Organization’s purpose Charitable: Yes
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 Yes
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 AHSAN ULLAH
Signature Title DIRECTOR PRESIDENT
Signature Date 3/30/2020

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