FORM 1023-EZ for DIANE E CURTIS MEDICAL SCHOLARSHIPFOUNDATION

Field Data
EIN 46-5676060
Case Number EO-2014240-000514
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DIANE E CURTIS MEDICAL SCHOLARSHIPFOUNDATION
Organization’s Mailing Address PO BOX 613
City NORWAY
State ME
ZIP 04268
Accounting period End 12
Primary contact name THOMAS CURTIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

THOMAS CURTIS
PRESIDENT
PO BOX 613
NORWAY ME 04268

Officer/Director/Trustee Two

SCOTT BERK
DIRECTOR
78 LAKE ROAD
OTISFIELD ME 04270

Officer/Director/Trustee Three

JAMES BOUCHARD
DIRECTOR
15 STRAWBERRY AVENUE
LEWISTON ME 04240

Officer/Director/Trustee Four

NICOLETTE ERICKSON
DIRECTOR
PO BOX 390
BETHEL ME 04217

Officer/Director/Trustee Five

MILES HUNT
DIRECTOR
PO BOX 349
NORWAY ME 04268

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/14/2014
Organization Incorporation State ME
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
Organization’s purpose Charitable: Yes
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 Yes
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
Signature Title
Signature Date

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