FORM 1023-EZ for MIND OVER MATTER SPORTS RELATED TBIAWARENESS INC

Field Data
EIN 81-1806266
Case Number EO-2016076-000341
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MIND OVER MATTER SPORTS RELATED TBIAWARENESS INC
Organization’s Mailing Address 7 CASTLE DR
City WOODBURY
State NY
ZIP 11797
Accounting period End 12
Primary contact name DAVID MOSENSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JENNA MOSENSON
EXECUTIVE DIRECTOR AND FOUNDER
7 CASTLE DR
WOODBURY NY 11797

Officer/Director/Trustee Two

DAVID MOSENSON
VICE PRESIDENT AND TREASURER
7 CASTLE DR
WOODBURY NY 11797

Officer/Director/Trustee Three

GAYLE MOSENSON
VICE PRESIDENT
7 CASTLE DR
WOODBURY NY 11797

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/4/2016
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G48 - Brain Disorders
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 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 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
Signature Title
Signature Date

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