FORM 1023-EZ for YC KIMS BLACK BELT SOCIETY

Field Data
EIN 83-1107299
Case Number EO-2018263-000385
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name YC KIMS BLACK BELT SOCIETY
Organization’s Mailing Address 4545 MARSHALL ROAD
City KETTERING
State OH
ZIP 45429-5716
Accounting period End 4
Primary contact name JAMES C NICHOLAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES NICHOLAS
TREASURER
2358 SOUTH PATTERSON BLVD APT 2
KETTERING OH 45409-1830

Officer/Director/Trustee Two

ERNEST OSBORN
VICE PRESIDENT
2308 SIENNA COURT
BELLBROOK OH 45304-2500

Officer/Director/Trustee Three

HARRY IDOL
PRESIDENT
2358 SOUTH PATTERSON BLVD APT 2
KETTERING OH 45409-1830

Officer/Director/Trustee Four

NADAR HENDIZADEH
SECRETARY
410 EAST MANOR DRIVE
SPRINGBORO OH 45066-5603

Officer/Director/Trustee Five

REBECCA LATHAM
TEST COORDINATOR
140 MALLARD GLEN DRIVE APT 8
CENTERVILLE OH 45458-3482

Organization’s website WWW.YCKIMBBS.COM
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/1/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
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 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 JAMES NICHOLAS
Signature Title TREASURER
Signature Date 9/18/18

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