FORM 1023-EZ for KIMBERLY MARIE KOZIAN MEMORIAL SCHOLARSHIP

Field Data
EIN 83-0938517
Case Number EO-2018232-000258
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KIMBERLY MARIE KOZIAN MEMORIAL SCHOLARSHIP
Organization’s Mailing Address 5139 MAPLERIDGE DR
City PORTAGE
State MI
ZIP 49024
Accounting period End 7
Primary contact name DENNIS KOZIAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAURI HANSEN
PRESIDENT
1001 WASHINGTON DR
LUCAS TX 75002-3706

Officer/Director/Trustee Two

DENNIS KOZIAN
TREASURER
5139
PORTAGE MI 49024

Officer/Director/Trustee Three

MARK HANSEN
SECRETARY
1001 WASHINGTON DR
LUCAS TX 75002-3706

Officer/Director/Trustee Four

SYLVIA KOZIAN
DIRECTOR
50077 LUDWIG CT
SHELBY TOWNSHIP MI 48317

Officer/Director/Trustee Five

SARAH KOZIAN
DIRECTOR
5139 MAPLERIDGE DR
PORTAGE MI 49024

Organization’s website
Organization’s email DKOZIAN@ATT.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/16/18
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 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 DENNIS KOZIAN
Signature Title TREASURER
Signature Date 8/16/18

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