FORM 1023-EZ for HEADS UP MENTORS

Field Data
EIN 84-3638297
Case Number EO-2021063-000352
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEADS UP MENTORS
Organization’s Mailing Address 6571 SHADY LAKE CT
City LEWIS CENTER
State OH
ZIP 43035
Accounting period End 11
Primary contact name RISHIKA GORAI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RISHIKA GORAI
EXECUTIVE DIRECTOR
6571 SHADY LAKE CT
LEWIS CENTER OH 43035

Officer/Director/Trustee Two

SETH LIYANAPATHIRANA
EXECUTIVE DIRECTOR
296 WATSON WAY
POWELL OH 43065

Officer/Director/Trustee Three

JESSICA MIAO
EXECUTIVE DIRECTOR
302 BALSAMINE DR
POWELL OH 43065

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/10/2019
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B20 - Elementary, Secondary Education, K - 12
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 Yes
Compensation of Officer director trustee No
Donation of funds Yes
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 Yes
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 RISHIKA GORAI
Signature Title EXECUTIVE DIRECTOR
Signature Date 12/28/2020

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