FORM 1023-EZ for SURGERY CLUB AT NC STATE CVM

Field Data
EIN 83-1129517
Case Number EO-2020245-000066
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SURGERY CLUB AT NC STATE CVM
Organization’s Mailing Address 1060 WILLIAM MOORE DRIVE
City RALEIGH
State NC
ZIP 27607
Accounting period End 4
Primary contact name ANDREW KUROWSKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANN GAIER
PRESIDENT
1060 WILLIAM MOORE DRIVE
RALEIGH NC 27607

Officer/Director/Trustee Two

SAMANTHA FROSCH
CO-PRESIDENT
1060 WILLIAM MOORE DRIVE
RALEIGH NC 27607

Officer/Director/Trustee Three

ANGELA RAZZA
VICE PRESIDENT
1060 WILLIAM MOORE DRIVE
RALEIGH NC 27607

Officer/Director/Trustee Four

ANDREW KUROWSKI
TREASURER
1060 WILLIAM MOORE DRIVE
RALEIGH NC 27607

Officer/Director/Trustee Five

SIDNEY SMITH
SECRETARY
1060 WILLIAM MOORE DRIVE
RALEIGH NC 27607

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/11/2018
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B80 - Student Services, Organizations of Students
Organization’s purpose Charitable: No
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ANDREW KUROWSKI
Signature Title TREASURER
Signature Date 8/28/2020

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