FORM 1023-EZ for LICSPA INC

Field Data
EIN 86-2136447
Case Number EO-2021137-000133
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LICSPA INC
Organization’s Mailing Address PO BOX 10041
City MELVILLE
State NY
ZIP 11747-0009
Accounting period End 12
Primary contact name KEVIN ADAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEVIN ADAMS
VP OF FINANCE
PO BOX 10041
MELVILLE NY 11747-0009

Officer/Director/Trustee Two

LEONARD BRETON
PRESIDENT
PO BOX 10041
MELVILLE NY 11747-0009

Officer/Director/Trustee Three

DENISE BONETA
EXECUTIVE VP
PO BOX 10041
MELVILLE NY 11747-0009

Officer/Director/Trustee Four

JOSEPH VERNACE
VP OF COMMUNICATIONS
PO BOX 10041
MELVILLE NY 11747-0009

Officer/Director/Trustee Five

BRITTANY RHODEN
VP OF DEVELOPMENT
PO BOX 10041
MELVILLE NY 11747-0009

Organization’s website LICSPA.ORG
Organization’s email FINANCE@LICSPA.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/15/2021
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B03 - Professional Societies, Associations
Organization’s purpose Charitable: No
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 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 KEVIN ADAMS
Signature Title VP OF FINANCE
Signature Date 5/12/2021

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