FORM 1023-EZ for KETAMINE ADVOCACY ALLIANCE

Field Data
EIN 82-1880388
Case Number EO-2018033-000156
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KETAMINE ADVOCACY ALLIANCE
Organization’s Mailing Address 1201 W 38TH ST
City SIOUX FALLS
State SD
ZIP 57105
Accounting period End 12
Primary contact name JOHN GEHM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN GEHM
PRESIDENT
1201 W 38TH ST
SIOUX FALLS SD 57105

Officer/Director/Trustee Two

ANDY RANK
VICE PRESIDENT
220 ROYAL JOHN MINE ROAD
SAN LORENZO NM 88041

Officer/Director/Trustee Three

RICHARD SMILEY
SECRETARY/TREASURER
923 PEACHTREE STREET UNIT 1533
ATLANTA GA 30309

Organization’s website KETAMINEADVOCACYALLIANCE.ORG
Organization’s email INFO@KETAMINEADVOCACYALLIANCE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/19/17
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 JOHN GEHM
Signature Title PRESIDENT
Signature Date 1/31/18

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