FORM 1023-EZ for KID CONNECTION THERAPEUTIC FOSTER CHILD AGENCY INC

Field Data
EIN 81-4205949
Case Number EO-2016300-000253
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KID CONNECTION THERAPEUTIC FOSTER CHILD AGENCY INC
Organization’s Mailing Address 206 MOREHEAD PLAZA
City MOREHEAD
State KY
ZIP 40351
Accounting period End 12
Primary contact name DAVID FULTZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DWAYNE JOHNSON
VICE PRESIDENT
445 FRANK BLEVINS ROAD
WEST LIBERTY KY 41472

Officer/Director/Trustee Two

DEBBIE MESSER
BOARD MEMBER
3550 OPEN FORK ROAD
MOREHEAD KY 40351

Officer/Director/Trustee Three

DOUG THOMAS
BOARD MEMBER
1850 OPEN FORK ROAD
MOREHEAD KY 40351

Officer/Director/Trustee Four

BONNIE WOOD
SECRETARY
103 MAHER DRIVE
MOREHEAD KY 40351

Officer/Director/Trustee Five

DAVID FILTZ
PRESIDENT
3600 OPEN FORK ROAD
MOREHEAD KY 40351

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/3/2016
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P32 - Foster Care
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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