FORM 1023-EZ for KAY S VISION ASSOCIATION

Field Data
EIN 46-2528692
Case Number EO-2017017-000664
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KAY S VISION ASSOCIATION
Organization’s Mailing Address 1671 CARSTARE DR
City COLUMBUS
State OH
ZIP 43227
Accounting period End 12
Primary contact name KAREN HENDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KAREN HENDERSON
PRESIDENT
1671 CARSTARE DR
COLUMBUS OH 43227

Officer/Director/Trustee Two

BRENDA GIBSON
TREASURER
1696 CARSTARE DR
COLUMBUS OH 43227

Officer/Director/Trustee Three

AUDREY F SANDERS
SECRETARY
2738 BRANDY DR APT 204
COLUMBUS OH 43232

Officer/Director/Trustee Four

YAVONNEA A HARVEY
VICE PRESIDENT
880 LINWOOD ST
COLUMUS OH 43206

Organization’s website
Organization’s email KAYS.VISION.PGH@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/2013
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family 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 Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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