FORM 1023-EZ for MAD KICKS

Field Data
EIN 87-1632103
Case Number EO-2021221-000234
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MAD KICKS
Organization’s Mailing Address 232 PROSPECT STREET
City BELLEVUE
State KY
ZIP 41073
Accounting period End 12
Primary contact name MARLENE THIES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARLENE THIES
DIRECTOR
232 PROSPECT STREET
BELLEVUE KY 41073

Officer/Director/Trustee Two

SHANNON FLADELAND
OFFICER
6629 EAST BEND ROAD
BURLINGTON KY 41005

Officer/Director/Trustee Three

LORI DEAL
OFFICER
119 HOLLY WOODS DRIVE
FT THOMAS KY 41075

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/13/2021
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MARLENE THIES
Signature Title DIRECTOR
Signature Date 8/5/2021

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