FORM 1023-EZ for KENTUCKY LYME DISEASE ASSOCIATION INC

Field Data
EIN 83-1663776
Case Number EO-2019035-000999
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KENTUCKY LYME DISEASE ASSOCIATION INC
Organization’s Mailing Address PO BOX 327
City COXS CREEK
State KY
ZIP 40013
Accounting period End 12
Primary contact name VICKY PETSY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VICKY PETSY
PRESIDENT
PO BOX 327
COXS CREEK KY 40013

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/27/18
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G80 - Specifically Named Diseases
Organization’s purpose Charitable: No
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 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 VICKY PETSY
Signature Title PRESIDENT
Signature Date 1/15/19

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