FORM 1023-EZ for MOTORSPORTS BRAIN & SPINE FOUNDATION
| Field | Data |
|---|---|
| EIN | 82-1725300 |
| Case Number | EO-2018128-001007 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | MOTORSPORTS BRAIN & SPINE FOUNDATION |
| Organization’s Mailing Address | 516 VEROT SCHOOL ROAD |
| City | LAFAYETTE |
| State | LA |
| ZIP | 70508 |
| Accounting period End | 12 |
| Primary contact name | STEFAN HAWKINS CPA |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JASON CORMIER
PRESIDENT/CEO
410 WORTH AVENUE
LAFAYETTE LA 70508
Officer/Director/Trustee Two
CYNTHIA FERNANDEZ
SECRETARY/TREASURER
516 VEROT SCHOOL ROAD
LAFAYETTE LA 70508
Officer/Director/Trustee Three
ALLAN APPLEY
VICE PRESIDENT
155 HOSPITAL DRIVE
LAFAYETTE LA 70508
Officer/Director/Trustee Four
ERICK KNEZEK
BOARD MEMBER
202A PRINCETON WOODS
LAFAYETTE LA 70508
Officer/Director/Trustee Five
DANI BIDROS
BOARD MEMBER
2222 GREENHOUSE ROAD SUITE 1100A
HOUSTON TX 77084
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 5/25/17 |
| Organization Incorporation State | LA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | M40 - Safety Education |
| Organization’s purpose | Charitable: Yes 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 | 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 | 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 | CYNTHIA FERNANDEZ |
| Signature Title | SECRETARY/TREASURER |
| Signature Date | 5/3/18 |
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