FORM 1023-EZ for QUALITY OF LIFE BEHAVIOR HEALTH SERVICE INC
| Field | Data |
|---|---|
| EIN | 83-1962384 |
| Case Number | EO-2018309-000420 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | QUALITY OF LIFE BEHAVIOR HEALTH SERVICE INC |
| Organization’s Mailing Address | 2400 DILWYN COURT |
| City | MATTHEWS |
| State | NC |
| ZIP | 28104 |
| Accounting period End | 12 |
| Primary contact name | C MARIA MACON |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
DANNY SMALLS
PRESIDENT
2400 DILWYN COURT
MATTHEWS NC 28104
Officer/Director/Trustee Two
JASUN WILLIAMS
VICE PRESIDENT
10322 OLDE IVY WAY
CHARLOTTE NC 28262
Officer/Director/Trustee Three
RENITA MYERS
SECRETARY
1338 GAMBEL DR NW
CONCORD NC 28027
Officer/Director/Trustee Four
TONI SNEED SMITH
DIRECTOR
11318 WARFIELD AVE
HUNTERSVILLE NC 28078
Officer/Director/Trustee Five
MARIAH JAMES
DIRECTOR
2240 FLAXMERE ROAD
CHARLOTTE NC 28262
| Organization’s website | |
|---|---|
| Organization’s email | DSMALLS339@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 9/25/18 |
| Organization Incorporation State | NC |
| 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: 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 | DANNY SMALLS |
| Signature Title | PRESIDENT |
| Signature Date | 11/2/18 |
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