FORM 1023-EZ for CHILDHOOD CANCER KIDS INC

Field Data
EIN 46-4366903
Case Number EO-2014256-000140
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHILDHOOD CANCER KIDS INC
Organization’s Mailing Address 26 MEETINGHOUSE LANE
City MADISON
State CT
ZIP 06443
Accounting period End 12
Primary contact name KIM PREVEZA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KIMBERLY PREVEZA
PRESIDENT
16 WINTERHILL RD
MADISON CT 06443

Officer/Director/Trustee Two

VANESSA BALLANTINE
TREASURER
10 FLINTLOCK RD
MADISON CT 06443

Officer/Director/Trustee Three

HELEN SISK
CHAIR
273 BARTLETT DRIVE
MADISON CT 06443

Officer/Director/Trustee Four

KATIE STEIN
SECRETARY
84 BARTLETT DRIVE
MADISON CT 06443

Organization’s website WWW.CHILDHOODCANCERKIDS.ORG
Organization’s email INFO@CHILDHOODCANCERKIDS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/8/2014
Organization Incorporation State CT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G30 - Cancer
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
Signature Title
Signature Date

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