FORM 1023-EZ for THE LAZARUS EXPERIENCE

Field Data
EIN 81-5075109
Case Number EO-2017039-000121
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE LAZARUS EXPERIENCE
Organization’s Mailing Address 1715 INDIAN WOOD CIR SUITE 200
City MAUMEE
State OH
ZIP 43537
Accounting period End 12
Primary contact name TOM OSTROSKY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TOM OSTROSKY
FOUNDER/DIRECTOR
1715 INDIAN WOOD CIR SUITE 200
MAUMEE OH 43537

Officer/Director/Trustee Two

KEVIN BOCK
BOARD MEMBER
7364 SAND WEDGE CT
WATERVILLE OH 43566

Officer/Director/Trustee Three

MIKE OSHEA
BOARD MEMBER
8217 DUTCH RD
WATERVILLE OH 43566

Organization’s website
Organization’s email LAZARUSEXPERIENCEORG@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/5/2017
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I40 - Rehabilitation Services for Offenders
Organization’s purpose Charitable: No
Religious: Yes
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 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
Signature Title
Signature Date

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