FORM 1023-EZ for ADAMS COUNTY SUICIDE AWARENESS AND PREVENTION

Field Data
EIN 81-3060380
Case Number EO-2017041-000206
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ADAMS COUNTY SUICIDE AWARENESS AND PREVENTION
Organization’s Mailing Address 78 CHRISDON LANE
City WEST UNION
State OH
ZIP 45693
Accounting period End 12
Primary contact name JASMINE OSMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JASMINE OSMAN
CHAIR
78 CHRISDON LANE
WEST UNION OH 45693

Officer/Director/Trustee Two

JILL COX
VICE CHAIR
4930 CHAPPARAL ROAD
WEST UNION OH 45693

Officer/Director/Trustee Three

JESSICA DILLOW
TREASURER
1100 HOG RUN ROAD
STOUT OH 45684

Officer/Director/Trustee Four

JADE OSMAN
SECRETARY
17697 STATE ROUTE 247
SEAMAN OH 45679

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/8/2017
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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