FORM 1023-EZ for PMHS TEAM 319 BOOSTERS INC

Field Data
EIN 47-3943526
Case Number EO-2015159-000521
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PMHS TEAM 319 BOOSTERS INC
Organization’s Mailing Address PO BOX 244
City ALTON BAY
State NH
ZIP 03810
Accounting period End 12
Primary contact name JON ST LAURENT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JON ST LAURENT
PRESIDENT, DIRECTOR
PO BOX 244
ALTON BAY NH 03810

Officer/Director/Trustee Two

JUSTIN AVERY
TREASURER, DIRECTOR
40 FOLLETT RD
CENTER HARBOR NH 03226

Officer/Director/Trustee Three

MICHELLE KELLEY
SECRETARY, DIRECTOR
20 AMHERST DR
CENTER BARNSTEAD NH 03225

Officer/Director/Trustee Four

MICHAEL KELLEY
DIRECTOR
20 AMHERST DR
CENTER BARNSTEAD NH 03225

Officer/Director/Trustee Five

SHARON KIERSTEAD
DIRECTOR
PO BOX 27
ALTON NH 03809

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/17/2015
Organization Incorporation State NH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: Yes
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 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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