FORM 1023-EZ for BELMONT HILLS ELEMENTARY HSA INC

Field Data
EIN 23-2994463
Case Number EO-2019186-000264
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BELMONT HILLS ELEMENTARY HSA INC
Organization’s Mailing Address 200 SCHOOL ST
City BALA CYNWYD
State PA
ZIP 19004
Accounting period End 6
Primary contact name THEODORE PENDERGRASS II
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MELISSA RAND
TREASURER
1276 BOBARN DRIVE
PENN VALLEY PA 19072

Officer/Director/Trustee Two

LIBBY COLLINS
PRESIDENT
218 LANTWYN LANE
NARBERTH PA 19072

Officer/Director/Trustee Three

STACEY KOOL
TREASURER
345 HIDDEN RIVER RD
PENN VALLEY PA 19072

Officer/Director/Trustee Four

BIZETTE GAILEWICZ
PRESIDENT
1600 HAGYS FORD ROAD UNIT6
PENN VALLEY PA 19072

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/7/19
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B24 - Primary, Elementary Schools
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: Yes
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 STACEY KOOL
Signature Title TREASURER
Signature Date 7/3/19

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