FORM 1023-EZ for ONE RBN WELLNESS INC

Field Data
EIN 85-0691141
Case Number EO-2020118-000528
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ONE RBN WELLNESS INC
Organization’s Mailing Address 501 S MAIN ST
City SHAWANO
State WI
ZIP 54166
Accounting period End 12
Primary contact name DREW LACEFIELD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ELIZABETH KELLEY
PRESIDENT
501 S MAIN ST
SHAWANO WI 54166

Officer/Director/Trustee Two

DREW LACEFIELD
CEO/CFO
501 S MAIN ST
SHAWANO WI 54166

Officer/Director/Trustee Three

TONI CALDWELL
VICE PRESIDENT
501 S MAIN ST
SHAWANO WI 54166

Officer/Director/Trustee Four

SHANNON CHAPMAN
SECRETARY
591 S MAIN ST
SHAWANO WI 54166

Officer/Director/Trustee Five

SARAH WHITE
OFFICER
591 S MAIN ST
SHAWANO WI 54166

Organization’s website WWW.ONERBNWELLNESS.WORDPRESS.COM
Organization’s email ONERBNWELLNESS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/13/2020
Organization Incorporation State WI
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 Yes
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 DREW LACEFIELD
Signature Title CEO/CFO
Signature Date 4/25/2020

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