FORM 1023-EZ for CENTRAL KENTUCKY WILDLIFE INC

Field Data
EIN 81-3131170
Case Number EO-2016196-000538
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CENTRAL KENTUCKY WILDLIFE INC
Organization’s Mailing Address 300 DALE LANE
City PAINT LICK
State KY
ZIP 40461
Accounting period End 12
Primary contact name KEVIN SIMMONS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEVIN SIMMONS
BOARD MEMBER
300 DALE LANE
PAINT LICK KY 40461

Officer/Director/Trustee Two

HEATHER HANCOCK
BOARD MEMBER
200 DALE LANE
PAINT LICK KY 40461

Officer/Director/Trustee Three

RACHEL PARRIETT
BOARD MEMBER
2554 OLD US HWY 25
BEREA KY 40403

Officer/Director/Trustee Four

JENNIFER FARMER
BOARD MEMBER
930 COPPER CREEK RD
BEREA KY 40403

Organization’s website KENTUCKYWILDLIFEHOSPITAL.ORG
Organization’s email CENTRALKYWILDLIFEHOSPITAL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/7/2016
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D99 - Animal-Related N.E.C.
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 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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