FORM 1023-EZ for ARCUS BEHAVIORAL HEALTH AND WELLNESS

Field Data
EIN 82-2095881
Case Number EO-2018324-000083
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ARCUS BEHAVIORAL HEALTH AND WELLNESS
Organization’s Mailing Address 5214 N WESTERN AVE STE 104
City CHICAGO
State IL
ZIP 60625-2410
Accounting period End 12
Primary contact name LOUIS V HAYNES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VICTOR PEREZ
BOARD PRESIDENT
5122 N CENTRAL PARK AVE
CHICAGO IL 60625-5515

Officer/Director/Trustee Two

KENDRA HAYNES
DIRECTOR
5122 N CENTRAL PARK AVE
CHICAGO IL 60625-5515

Officer/Director/Trustee Three

CRYSTAL REYES
DIRECTOR
4625 RAYMOND AVE
BROOKFIELD IL 60513

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/27/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F32 - Community Mental Health Center
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name VICTOR PEREZ
Signature Title BOARD PRESIDENT
Signature Date 11/18/18

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