FORM 1023-EZ for COLLINCARESCURECANCER CORP

Field Data
EIN 47-4817591
Case Number EO-2015232-000419
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COLLINCARESCURECANCER CORP
Organization’s Mailing Address 1035 LARKENS WAY
City MEDINA
State OH
ZIP 44256-1275
Accounting period End 12
Primary contact name ELIZABETH KIOUSIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

COLLIN KIOUSIS
DIRECTOR
1035 LARKENS WAY
MEDINA OH 44256-1275

Officer/Director/Trustee Two

CONNIE GARDNER
DIRECTOR
1035 LARKENS WAY
MEDINA OH 44256-1275

Officer/Director/Trustee Three

ELIZABETH KIOUSIS
DIRECTOR
1035 LARKENS WAY
MEDINA OH 44256-1275

Officer/Director/Trustee Four

THOMAS KIOUSIS III
DIRECTOR
1035 LARKENS WAY
MEDINA OH 44256-1275

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/24/2015
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H05 - Research Institutes and/or Public Policy Analysis
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 Yes
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
Signature Title
Signature Date

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