| Field | Data |
|---|---|
| EIN | 81-5137046 |
| Case Number | EO-2017030-000453 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | DR KS FAMILY MEDICINE |
| Organization’s Mailing Address | 2871 S COLUMBIA ST |
| City | BOGALUSA |
| State | LA |
| ZIP | 70433 |
| Accounting period End | 12 |
| Primary contact name | KEISHA HARVEY |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
TASHIBA NELSON
DIRECTOR
233 N MAIN ST APT 510
GREENVILLE SC 29601
JUDY PETERS
SECRETARY
1020 JOHNSON ST
DAWSON GA 39842
ANTOINETTE DUKES
TREASURER
861 FONNIC DRIVE
NASHVILLE TN 37207
ALPHA WILSON
TRUSTEES
1913 GREENLAW
FRANKLINTON LA 70438
KEISHA HARVEY
TRUSTEE
70124 3RD ST
CO LA 70433
| Organization’s website | |
|---|---|
| Organization’s email | KHARVEY08@EMAIL.MMC.EDU |
| Organization Incorporated | No |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/27/2017 |
| Organization Incorporation State | LA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E30 - Health Treatment Facilities, Primarily Outpatient |
| 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 | No |
| One Third Support Gifts | Yes |
| 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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