FORM 1023-EZ for UXBRIDGE YOUTH FIELD HOCKEY ASSOCIATION INC

Field Data
EIN 82-3163336
Case Number EO-2017326-000261
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name UXBRIDGE YOUTH FIELD HOCKEY ASSOCIATION INC
Organization’s Mailing Address 42 S MAIN STREET
City UXBRIDGE
State MA
ZIP 01569
Accounting period End 9
Primary contact name LAUREN BOUCHARD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAUREN BOUCHARD
PRESIDENT
42 SOUTH MAIN STREET
UXBRIDGE MA 01569

Officer/Director/Trustee Two

BETHANY DZIVASEN
TREASURER
74 ACORN DRIVE
UXBRIDGE MA 01569

Officer/Director/Trustee Three

JODY BLOOD
SECRETARY
135 RIVULET STREET
UXBRIDGE MA 01569

Officer/Director/Trustee Four

KELLY ROSBOROUGH
VICE PRESIDENT
1 HENRY STREET
UXBRIDGE MA 01569

Officer/Director/Trustee Five

KARA CAMMUSO
DIRECTOR
15 STOREY LANE
UXBRIDGE MA 01569

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/22/2017
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 Yes
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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