FORM 1023-EZ for STOP CONCUSSIONS USA INC

Field Data
EIN 47-2216092
Case Number EO-2015007-000292
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name STOP CONCUSSIONS USA INC
Organization’s Mailing Address 12 NIBLICK WAY
City NORTH READING
State MA
ZIP 01864
Accounting period End 12
Primary contact name JAMI URETSKY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JAMI URETSKY
PRESIDENT, DIRECTOR
12 NIBLICK WAY
NORTH READING MA 01864

Officer/Director/Trustee Two

LORI HULAK
CLERK, TREASURER, DIRECTOR
76 FURNACE STREET
SHARON MA 02067

Officer/Director/Trustee Three

KERRY GOULET
DIRECTOR
56 KINGLAND CRESCENT
NORTH YORK, ONTARIO

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/11/2014
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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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