FORM 1023-EZ for MYSTIC GERIATRICS INSTITUTE INC

Field Data
EIN 82-0849120
Case Number EO-2017081-000228
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MYSTIC GERIATRICS INSTITUTE INC
Organization’s Mailing Address 12 ROOSEVELT AVE
City MYSTIC
State CT
ZIP 06355
Accounting period End 12
Primary contact name CHRISTINE GROCHOWSKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RUTH WALKER
OFFICER
186 JERRY BROWNE ROAD
MYSTIC CT 06355

Officer/Director/Trustee Two

MARY RILEY
OFFICER
10 CHIPPECHAUG TRAIL
MYSTIC CT 06355

Officer/Director/Trustee Three

CURTIS LYNCH
OFFICER
188 WATER STREET
STONINGTON CT 06378

Officer/Director/Trustee Four

MICHAEL FELLES
OFFICER
3 HERON ROAD
MYSTIC CT 06355

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/20/2015
Organization Incorporation State CT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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