FORM 1023-EZ for TEAM BROKEN GEAR INC

Field Data
EIN 47-5463334
Case Number EO-2017219-000167
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TEAM BROKEN GEAR INC
Organization’s Mailing Address 4160 OLD POST ROAD SUITE 202
City CHARLESTOWN
State RI
ZIP 02813-2520
Accounting period End 12
Primary contact name DANIEL REILLY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERIC KROPIWNICKI
OFFICER
104 HOPYARD ROAD
EAST HADDAM CT 06423-1726

Officer/Director/Trustee Two

STEPHEN DAMICO
OFFICER
34 NAUTILUS DRIVE WEST
SOUTH KINGSTOWN RI 02879-5009

Officer/Director/Trustee Three

DANIEL REILLY
EXECUTIVE DIRECTOR
166 WINDTREE STREET
TORRINGTON CT 06790-7903

Organization’s website HTTPS://WWW.TEAMBROKENGEAR.ORG/
Organization’s email DREILLY@TEAMBROKENGEAR.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/30/2015
Organization Incorporation State RI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 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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