FORM 1023-EZ for SOCIETY FOR OPIOID FREE ANESTHESIA
| Field | Data |
|---|---|
| EIN | 81-7049630 |
| Case Number | EO-2019077-000746 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | SOCIETY FOR OPIOID FREE ANESTHESIA |
| Organization’s Mailing Address | 7941 RAVENNA RD |
| City | HUDSON |
| State | OH |
| ZIP | 44236 |
| Accounting period End | 12 |
| Primary contact name | ALLAN R IMMONEN III |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
TOM BARIBEAULT
PRESIDENT
6005 OLD SOUTH DR
RICHMOND KY 40475
Officer/Director/Trustee Two
LARRY HORNSBY
PRESIDENT-ELECT
3310 KELLY CREEK RD
MOODY AL 35004
Officer/Director/Trustee Three
MARY NGUYEN
SECRETARY
7 ELLA WAY
PADUCAH KY 42001
Officer/Director/Trustee Four
ANDREW HARTZELL
TREASURER
2443 CARTIER ST
FAYETTEVILLE AR 72704
| Organization’s website | HTTPS://GOOPIOIDFREE.COM/ |
|---|---|
| Organization’s email | TOM@GOOPIOIDFREE.COM |
| Organization Incorporated | |
| Organization trust | Yes |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 3/7/17 |
| Organization Incorporation State | OH |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | G90 - Medical Disciplines |
| Organization’s purpose | Charitable: No 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 | 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 | TOM BARIBEAULT |
| Signature Title | PRESIDENT |
| Signature Date | 3/16/19 |
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