FORM 1023-EZ for KENTUCKY COUNCILOF CITIZENS WITH LOW VISION INC

Field Data
EIN 83-4511325
Case Number EO-2019164-000267
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KENTUCKY COUNCILOF CITIZENS WITH LOW VISION INC
Organization’s Mailing Address 155 N BELLAIRE AVE
City LOUISVILLE
State KY
ZIP 40206
Accounting period End 12
Primary contact name CARLA RUSCHIVAL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHIRLEY STIVERS
PRESIDENT
229 POPLAR
BELLEVUE KY 41073

Officer/Director/Trustee Two

AMANDA SELM
VICE PRESIDENT
3803 YARDLEY CT APT 104
LOUISVILLE KY 40299

Officer/Director/Trustee Three

PATRICIA COX
SECRETARY
3817 TUESDAY WAY
LOUISVILLE KY 40219

Officer/Director/Trustee Four

DAVID SMITH
TREASURER
3802 LANDHERR DR
LOUISVILLE KY 40299

Organization’s website KENTUCKY-ACB.ORG
Organization’s email KCB@KENTUCKY-ACB.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/28/19
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P86 - Blind/Visually Impaired Centers, Services
Organization’s purpose Charitable: Yes
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 PATRICIA COX
Signature Title SECRETARY
Signature Date 6/11/19

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