FORM 1023-EZ for SOCIETY OF ULTRASOUND AND PAIN MANAGEMENT

Field Data
EIN 84-3623348
Case Number EO-2021090-000090
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SOCIETY OF ULTRASOUND AND PAIN MANAGEMENT
Organization’s Mailing Address 7941 RAVENNA RD
City HUDSON
State OH
ZIP 44236
Accounting period End 12
Primary contact name BILL JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BILL JOHNSON
CHAIR
315 HOSPITAL DRIVE PO BOX 417
MADISON OH 37115

Officer/Director/Trustee Two

SCOTT URIGEL
VICE CHAIR
11800 EDINBORO LN
AUBURN OH 44023

Officer/Director/Trustee Three

STACE DOLLAR
TREASURER
3676 HORSEMINT TRAIL
LEXINGTON KY 40509

Officer/Director/Trustee Four

DAN NASH
BOARD MEMBER
3000 CACTUS DRIVE
EDMOND OK 73013

Officer/Director/Trustee Five

CHRISTIAN FALYAR
BOARD MEMBER
123 MANORDALE DRIVE
CHAPEL HILL NC 27517

Organization’s website HTTPS://JOINSUPM.COM/ABOUTSUPM/
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/7/2019
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G03 - Professional Societies, Associations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 BILL JOHNSON
Signature Title CHAIR
Signature Date 2/16/2021

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