FORM 1023-EZ for HEAD INJURY TREATMEN CORP

Field Data
EIN 83-1538743
Case Number EO-2018262-000209
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEAD INJURY TREATMEN CORP
Organization’s Mailing Address 290 NE 5TH AVE 19
City DELRAY BEACH
State FL
ZIP 33483
Accounting period End 12
Primary contact name WILLIAM DORTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM DORTON
PRESIDENT
290 NE 5TH AVE 19
DELRAY BEACH FL 33483

Officer/Director/Trustee Two

BRADLEY CHAPMAN
VP
290 NE 5TH AVE 19
DELRAY BEACH FL 33483

Officer/Director/Trustee Three

JARRETT SOLIMANDO
VP
290 NE 5TH AVE 19
DELRAY BEACH FL 33483

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/10/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - 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 Yes
Donation of funds Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name WILLIAM DORTON
Signature Title PRESIDENT
Signature Date 9/17/18

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