FORM 1023-EZ for ORTHOGNATHIC SURGERY ASSOCIATION INC

Field Data
EIN 83-3501918
Case Number EO-2019074-000632
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ORTHOGNATHIC SURGERY ASSOCIATION INC
Organization’s Mailing Address 101 OLD SHORT HILLS ROAD PH 2
City WEST ORANGE
State NJ
ZIP 7052
Accounting period End 12
Primary contact name ROBERT KOSICKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN AMATO
PRESIDENT/TRUSTEE
101 OLD SHORT HILLS ROAD PH 2
WEST ORANGE NJ 7052

Officer/Director/Trustee Two

CYRUS AMATO
TRUSTEE
101 OLD SHORT HILLS ROAD PH 2
WEST ORANGE NJ 7052

Officer/Director/Trustee Three

GREGG JACOB
TRUSTEE
83 HANOVER ROAD SUITE 240
FLORHAM PARK NJ 7932

Officer/Director/Trustee Four

SHAHID AZIZ
TRUSTEE
83 HANOVER ROAD SUITE 240
FLORHAM PARK NJ 7932

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/29/19
Organization Incorporation State NJ
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 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 JOHN AMATO
Signature Title PRESIDENT/TRUSTEE
Signature Date 3/13/19

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