FORM 1023-EZ for SHAWN COURTNEY MEMORIAL INC

Field Data
EIN 83-1155636
Case Number EO-2018197-000321
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SHAWN COURTNEY MEMORIAL INC
Organization’s Mailing Address 86 STRONG AVENUE
City PITTSFIELD
State MA
ZIP 1201
Accounting period End 12
Primary contact name DEBRA KIELMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICHARD COURTNEY
PRESIDENT
71 GLOVER AVENUE APT 3
QUINCY MA 2171

Officer/Director/Trustee Two

DEBRA KIELMAN
TREASURER
86 STRONG AVENUE
PITTSFIELD MA 1201

Officer/Director/Trustee Three

KATHLEEN COURTNEY
CLERK
86 STRONG AVENUE
PITTSFIELD MA 1201

Officer/Director/Trustee Four

MARY COURTNEY
DIRECTOR
174 MIDDLEFIELD
MIDDLEFIELD MA 1243

Officer/Director/Trustee Five

KEVIN COURTNEY
DIRECTOR
407 21ST STREET
DENVER CO 80205

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/6/18
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S12 - 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 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 DEBRA KIELMAN
Signature Title TREASURER
Signature Date 7/12/18

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