FORM 1023-EZ for BEREAVEMED INC

Field Data
EIN 84-2101215
Case Number EO-2020097-000059
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BEREAVEMED INC
Organization’s Mailing Address 151 ROBINSON ST APT 38
City PITTSBURGH
State PA
ZIP 15213
Accounting period End 12
Primary contact name MARTIN STERLICCHI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KORTNI WATKINS
PRESIDENT
151 ROBINSON ST APT 38
PITTSBURGH PA 15213

Officer/Director/Trustee Two

MARTIN STERLICCHI
TREASURER
151 ROBINSON ST APT 38
PITTSBURGH PA 15213

Officer/Director/Trustee Three

PRIYA ROY
VICE-PRESIDENT
309 W WASHINGTON AVE UNIT 103
MADISON WI 53703

Organization’s website BEREAVEMED.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/17/2019
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F99 - Mental Health, Crisis Intervention N.E.C.
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 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MARTIN STERLICCHI
Signature Title TREASURER
Signature Date 4/2/2020

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