FORM 1023-EZ for MIKE SULLY SULLIVAN CHARITY POKER RUN INC

Field Data
EIN 84-2562105
Case Number EO-2019310-000141
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MIKE SULLY SULLIVAN CHARITY POKER RUN INC
Organization’s Mailing Address 112 BLACK ASH RD
City OAKDALE
State CT
ZIP 6370
Accounting period End 12
Primary contact name CYNTHIA THOMPSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES MITCHELL
PRESIDENT
112 BLACK ASH RD
OAKDALE CT 6370

Officer/Director/Trustee Two

GEORGE EVANS
VICE PRESIDENT
140 RTE 163
MONTVILLE CT 6353

Officer/Director/Trustee Three

CAROLYN EVANS
SECRETARY
140 RTE 163
MONTVILLE CT 6353

Officer/Director/Trustee Four

DANIELLE SULLIVAN
DIRECTOR
7 SILVER FALLS RD
OAKDALE CT 6370

Officer/Director/Trustee Five

LAURA AMBROSI-FERGUSON
DIRECTOR
233 RATHBUN HILL RD
SALEM CT 6420

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/10/19
Organization Incorporation State CT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
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 JAMES MITCHELL
Signature Title PRESIDENT
Signature Date 11/4/19

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