FORM 1023-EZ for WESTBROOK SENIOR HOUSING INC

Field Data
EIN 47-3204591
Case Number EO-2018242-000147
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WESTBROOK SENIOR HOUSING INC
Organization’s Mailing Address 30 LIZA HARMON DR
City WESTBROOK
State ME
ZIP 4092-5709
Accounting period End 12
Primary contact name PAWEL PIETRZAK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTOPHER LAROCHE
PRESIDENT
30 LIZA HARMON DR OFC 500
WESTBROOK ME 4092-5709

Officer/Director/Trustee Two

THOMAS PERREY
TREASURER
8 MERRILL RD
WESTBROOK ME 4092

Officer/Director/Trustee Three

RICHARD BEGIN
SECRETARY
30 LIZA HARMON DR OFC 500
WESTBROOK ME 4092

Officer/Director/Trustee Four

THOMAS PERREY
DIRECTOR
8 MERRILL RD
WESTBROOK ME 4092

Officer/Director/Trustee Five

THOMAS BARTELL
DIRECTOR
8 SCHOOL RD
WINDHAM ME 4062

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/9/15
Organization Incorporation State ME
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S47 - Real Estate Organizations
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CHRISTOPHER LAROCHE
Signature Title PRESIDENT
Signature Date 8/28/18

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