FORM 1023-EZ for ARKANSAS BEHAVIORAL HEALTH INTEGRATION NETWORK
| Field | Data |
|---|---|
| EIN | 84-2019005 |
| Case Number | EO-2019325-000294 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | ARKANSAS BEHAVIORAL HEALTH INTEGRATION NETWORK |
| Organization’s Mailing Address | 35 SUNSHINE POINTE |
| City | HIGDEN |
| State | AR |
| ZIP | 72067 |
| Accounting period End | 12 |
| Primary contact name | KIMBERLY SHULER |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
PATRICIA GIBSON
PRESIDENT
2512 RIVERFRONT DRIVE 3
LITTLE ROCK AR 72202
Officer/Director/Trustee Two
KIMBERLY SHULER
VICE PRESIDENT EXECUTIVE DIRECTOR
1460 WINDSOR PLACE
FAYETTEVILLE AR 72703
Officer/Director/Trustee Three
STACIE CHALUPKA
SECRETARY AND TREASURER
1914 BROOKFORD DRIVE
LITTLE ROCK AR 72211
| Organization’s website | ABHINETWORK.ORG |
|---|---|
| Organization’s email | |
| Organization Incorporated | No |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 6/4/19 |
| Organization Incorporation State | AR |
| 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: No 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 | 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 | KIMBERLY SHULER |
| Signature Title | VICE PRESIDENT EXECUTIVE DIRECTOR |
| Signature Date | 11/19/19 |
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