FORM 1023-EZ for URCHOICE

Field Data
EIN 47-2399347
Case Number EO-2016004-000157
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name URCHOICE
Organization’s Mailing Address 1300 15TH ST SUITE 2
City LAWRENCEVILLE
State IL
ZIP 62439
Accounting period End 12
Primary contact name ROBERT HOPKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JERRY PACHALSKI
PRESIDENT
508 20TH ST
LAWRENCEVILLE IL 62439

Officer/Director/Trustee Two

BRAD PURCELL
VICE-PRESIDENT
804 E STATE ST
BRIDGEPORT IL 62417

Officer/Director/Trustee Three

ROBERT HOPKINS
SECRETARY
11478 CLUB KILROY RD
BRIDGEPORT IL 62417

Officer/Director/Trustee Four

GAY KAVANAUGH
TREASURER
10360 CHESAPEAKE LANE
LAWRENCEVILLE IL 62439

Officer/Director/Trustee Five

MARK SHANER
DIRECTOR
PO BOX 8596
ROBINSON IL 62454

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/16/2013
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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
Signature Title
Signature Date

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