FORM 1023-EZ for BRANDON BLAKE HAWKINS ADULT CARE SERVICES INC

Field Data
EIN 81-3971010
Case Number EO-2016279-000243
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BRANDON BLAKE HAWKINS ADULT CARE SERVICES INC
Organization’s Mailing Address 1759 CRANBERRY COURT
City MANSFIELD
State OH
ZIP 44905
Accounting period End 12
Primary contact name CHARLESETTA HAWKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHARLESETTA HAWKINS
CEO
1759 CRANBERRY COURT
MANSFIELD OH 44905

Officer/Director/Trustee Two

PRISTELL DOGINS III
PRESIDENT
1759 CRANBERRY COURT
MANSFIELD OH 44905

Officer/Director/Trustee Three

KATHY BARTON-BROWN
VICE PRESIDENT
1759 CRANBERRY COURT
MANSFIELD OH 44905

Officer/Director/Trustee Four

KELI MARIE BONNER
SECRETARY
1759 CRANBERRY COURT
MANSFIELD OH 44905

Officer/Director/Trustee Five

JEREESE WILSON
TREASURER
1759 CRANBERRY COURT
MANSFIELD OH 44905

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/27/2016
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
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
Signature Title
Signature Date

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