FORM 1023-EZ for A KORNERSTONE YOUTH SERVICES

Field Data
EIN 83-3184875
Case Number EO-2019036-000525
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name A KORNERSTONE YOUTH SERVICES
Organization’s Mailing Address 2813 CHERRY BLOSSOM COURT
City WALDORF
State KY
ZIP 20603
Accounting period End 12
Primary contact name ANGEL BLACK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERNEST BLACK
TREASURER
2813 CHERRY BLOSSOM COURT
WALDORF MD 20603

Officer/Director/Trustee Two

KAREN BUCKNER
SECRETARY
7814 BRIDLEWOOD PLACE
LOUISVILLE KY 40228

Officer/Director/Trustee Three

GEORGINIA JOHNSON
VICE CHAIR
4637 W 105TH PLACE
OAK LAWN IL 60453

Officer/Director/Trustee Four

MARCIA MCGINNIS
COMMITTE CHAIR
7104 WIND VALLEY COURT
GREENVILLE IN 47124

Officer/Director/Trustee Five

ANGEL BLACK
CEO
2813 CHERRY BLOSSOM COURT
WALDORF MD 20603

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/18/19
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P73 - Group Home (Long Term)
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 ANGEL BLACK
Signature Title CEO
Signature Date 1/18/19

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