FORM 1023-EZ for SAMARA SELF-PROPELLED LEARNING FOR TEENS INC

Field Data
EIN 82-1854471
Case Number EO-2017186-000113
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SAMARA SELF-PROPELLED LEARNING FOR TEENS INC
Organization’s Mailing Address PO BOX 73
City MONSON
State MA
ZIP 01057-0073
Accounting period End 6
Primary contact name MARY GELEZUNAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUSTIN BERAK
PRESIDENT
7 JOLLY ROAD
ELLINGTON CT 06029-3702

Officer/Director/Trustee Two

CHRISTINA GILLIGAN
TREASURER
14 GREEN STREET
MONSON MA 01057-1212

Officer/Director/Trustee Three

ANTONIA PALFREY
CLERK
52 MUNN ROAD
MONSON MA 01057-9649

Officer/Director/Trustee Four

MARY GELEZUNAS
EXECUTIVE DIRECTOR
35 GREEN STREET
MONSON MA 01057-1228

Officer/Director/Trustee Five

KAI PRICE
DIRECTOR
35 GREEN STREET
MONSON MA 01057-1228

Organization’s website WWW.SAMARATEENS.ORG
Organization’s email INFO@SAMARATEENS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/22/2017
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B80 - Student Services, Organizations of Students
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 Yes
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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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