FORM 1023-EZ for REVIVE OHIO MOBILE OUTREACH INC

Field Data
EIN 86-3183518
Case Number EO-2021203-000309
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name REVIVE OHIO MOBILE OUTREACH INC
Organization’s Mailing Address 14034 STALEY ROAD
City ANNA
State OH
ZIP 45302
Accounting period End 12
Primary contact name KRISTINE H REED
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARK BURD
PRESIDENT AND DIRECTOR
14034 STALEY ROAD
ANNA OH 45302

Officer/Director/Trustee Two

AMY HARMAN
SEC-TREAS AND DIRECTOR
13232 REED ROAD
YORKSHIRE OH 45388

Officer/Director/Trustee Three

ROBERT WARREN
DIRECTOR
701 HENDRICKS AVENUE
SAINT MARYS OH 45885

Officer/Director/Trustee Four

NEAL WHITNEY
DIRECTOR
110 GREGORY LANE
ELIDA OH 45807

Officer/Director/Trustee Five

SCOTT MCKENZIE
DIRECTOR
2069 HIGH RIDGE ROAD
LIMA OH 45805

Organization’s website REVIVEOHIOMOBILEOUTREACH.COM
Organization’s email PRAYER@REVIVEOH.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/14/2021
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: Yes
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 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MARK BURD
Signature Title PRESIDENT AND DIRECTOR
Signature Date 7/20/2021

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