FORM 1023-EZ for THOMAS BRAIN INTEGRATION SERVICES CENTER INC

Field Data
EIN 90-1020339
Case Number EO-2016343-000273
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THOMAS BRAIN INTEGRATION SERVICES CENTER INC
Organization’s Mailing Address 14710 HIRAM CLARKE ROAD
City HOUSTON
State TX
ZIP 77053
Accounting period End 12
Primary contact name VICTORIA ESSIEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHIRLEY TRUBY
BOARD OF DIRECTORS
8759 COPPERBROOK
HOUSTON TX 77053

Officer/Director/Trustee Two

MOSES WILCOX
BOARD OF DIRECTORS
120 SOUTH 27TH STREET
NEDERLANDS TX 77095

Officer/Director/Trustee Three

LARRY HUMPHREY III
BOARD OF DIRECTORS
4207 HAMBLEDON VILLAGE
HOUSTON TX 77014

Officer/Director/Trustee Four

MARTIN ESSIEN
CHIEF FINANCIAL OFFICER
13805 HIRAM CLARKE
HOUSTON TX 77045

Officer/Director/Trustee Five

VICTORIA ESSIEN
CHIEF OPERATING OFFICER
15003 NUWOOD
HOUSTON TX 77053

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/23/2013
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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