FORM 1023-EZ for NASHOBA VALLEY EMS INC

Field Data
EIN 43-3383872
Case Number EO-2017131-000335
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NASHOBA VALLEY EMS INC
Organization’s Mailing Address 45 FARMERS ROAD
City GROTON
State MA
ZIP 01450
Accounting period End 12
Primary contact name SUSAN DALY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID HARGRAVE
PRESIDENT
28 MASON STREET
PEPPERELL MA 01463

Officer/Director/Trustee Two

SUSAN DALY
TREASURER
1A MAIN STREET
GROTON MA 01450

Officer/Director/Trustee Three

TIMOTHY KELLY
CLERK
101 BALL HILL ROAD
PRINCETON MA 01541

Officer/Director/Trustee Four

JEREMY JANUSKIEWICZ
DIRECTOR
129 LONGLEY ROAD
GROTON MA 01450

Officer/Director/Trustee Five

ALBERT DESHLER
DIRECTOR
19 MAIN STREET
SHIRLEY MA 01464

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/2/1997
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M41 - First Aid Training, Services
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
Signature Title
Signature Date

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