FORM 1023-EZ for BETHANY HOMES

Field Data
EIN 84-3626063
Case Number EO-2019317-000014
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BETHANY HOMES
Organization’s Mailing Address 1090 GRACE ST
City MANSFIELD
State OH
ZIP 44905
Accounting period End 12
Primary contact name ELIZABETH CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ELIZABETH CLARK
PRESIDENT
3230 POSSUM RUN RD
MANSFIELD OH 44903

Officer/Director/Trustee Two

JAMES CLARK
TREASURER
7100 COUNTY RD 57
LEXINGTON OH 44904

Officer/Director/Trustee Three

JACKYLENE WHITE
SECRETARY
3230 POSSUM RUN RD
MANSFIELD OH 44903

Officer/Director/Trustee Four

TIMOTHY CLARK
YOUTH DIRECTOR
7100 COUNTY RD 57
LEXINGTON OH 44904

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/7/19
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 Yes
Donation of funds Yes
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 ELIZABETH CLARK
Signature Title PRESIDENT
Signature Date 11/8/19

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