FORM 1023-EZ for INTERNATIONAL PEDIATRIC SIMULATIONSOCIETY

Field	Data
EIN	82-3390260
Case Number	EO-2019266-000259
Form 1023-EZ version	12018
Eligibility Worksheet	1
Organization Name	INTERNATIONAL PEDIATRIC SIMULATIONSOCIETY
Organization’s Mailing Address	7304 WEST 130TH STREET SUITE 370
City	OVERLAND PARK
State	KS
ZIP	66213
Accounting period End	12
Primary contact name	DENISE BARRON
Primary contact phone	[Hidden]
Primary contact phone extension	[Hidden]
Primary contact fax	[Hidden]
User fee submitted	$275.00

Officer/Director/Trustee One

TOBIAS EVERETT
PRESIDENT
555 UNIVERSITY AVE DEPT ANESTHESIA
TORONTO

Officer/Director/Trustee Two

LYDIA LOFTON
PRESIDENT ELECT
36 PINE HOUSE 197 TOWNMEAD ROAD
LONDON

Officer/Director/Trustee Three

MONICA EVANS-LOMBE
EXECUTIVE DIRECTOR
8900 W 72ND ST
OVERLAND PARK KS 66204-1135

Officer/Director/Trustee Four

ROBERTA HALES
SECRETARY
207 PACER LANE
PHILADELPHIA PA 19426

Officer/Director/Trustee Five

MICHAEL SEROPIAN
TREASURER
14043 EDENBERRY COURT
PORTLAND OR 97035

Organization’s website	WWW.IPSSGLOBAL.ORG
Organization’s email	INFO@IPSSGLOBAL.ORG
Organization Incorporated	Yes
Organization trust	No
Necessary Organizing Documents	Yes
Organization Incorporation Date	10/2/17
Organization Incorporation State	KS
Contains Limitation	Yes
Does not expressly empower	Yes
Contains dissolution	Yes
National Taxonomy of Exempt Entities (NTEE) code	A03 - 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	Yes
Conducting Activities Outside of United States	Yes
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	MONICA EVANS-LOMBE
Signature Title	EXECUTIVE DIRECTOR
Signature Date	9/19/19
EIN	82-3390260
Case Number	EO-2019266-000259
Form 1023-EZ version	12018
Eligibility Worksheet	1
Organization Name	INTERNATIONAL PEDIATRIC SIMULATION SOCIETY
Organization’s Mailing Address	7304 WEST 130TH STREET SUITE 370
City	OVERLAND PARK
State	KS
ZIP	66213
Accounting period End	12
Primary contact name	DENISE BARRON
Primary contact phone	[Hidden]
Primary contact phone extension	[Hidden]
Primary contact fax	[Hidden]
User fee submitted	$275.00