FORM 1023-EZ for BAY STATE BRAWLERS ROLLER DERBY INC

Field Data
EIN 37-1658359
Case Number EO-2019169-000532
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BAY STATE BRAWLERS ROLLER DERBY INC
Organization’s Mailing Address 499 ELECTRIC AVENUE BOX 164
City FITCHBURG
State MA
ZIP 1420
Accounting period End 12
Primary contact name MEGHAN BEAULIEU
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MEGHAN BEAULIEU
PRESIDENT
28 PARTRIDGE HILL ROAD
HARVARD MA 1451

Officer/Director/Trustee Two

HEATHER JOHNSON
VICE PRESIDENT
17 PIPER ROAD
ACTON MA 1720

Officer/Director/Trustee Three

MARISSA DIAZ
CLERK
11 QUINT AVE APT 2
ALLSTON MA 2134

Officer/Director/Trustee Four

JESSICA PEETE
TREASURER
25 HARRIS STREET APT 16
ACTON MA 1720

Officer/Director/Trustee Five

ALLISON BALIK
DIRECTOR
41 MARION STREET APT 2
MEDFORD MA 2155

Organization’s website WWW.BAYSTATEBRAWLERS.COM
Organization’s email INFO@BAYSTATEBRAWLERS.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/12
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N50 - Recreational, Pleasure, or Social Club
Organization’s purpose Charitable: No
Religious: No
Educational: No
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 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 JESSICA PEETE
Signature Title TREASURER
Signature Date 6/14/19

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