FORM 1023-EZ for NORTHERN OHIO VASCULAR ASSOCIATION

Field Data
EIN 83-3922359
Case Number EO-2019178-000153
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NORTHERN OHIO VASCULAR ASSOCIATION
Organization’s Mailing Address 19345 RIVERVIEW AVENUE
City ROCKY RIVER
State OH
ZIP 44116
Accounting period End 1
Primary contact name DAX GODKIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAX GODKIN
PRESIDENT
19345 RIVERVIEW AVENUE
ROCKY RIVER OH 44116

Officer/Director/Trustee Two

SUSAN WHITELAW
SECRETARY
9359 MONTICELLO DRIVE
TWINSBURG OH 44087

Officer/Director/Trustee Three

SANDRA YESENKO
TREASURER
248 MAIN STREET APT 404
WESTLAKE OH 44145

Officer/Director/Trustee Four

LARRY RABER
BOARD MEMBER
24715 SNELL ROAD
COLUMBIA STATION OH 44028

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/19
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C03 - Professional Societies, Associations
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 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 DAX GODKIN
Signature Title PRESIDENT
Signature Date 6/25/19

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