FORM 1023-EZ for OUR BROTHERS KEEPER WELLNESS ORGANIZATION

Field Data
EIN 41-2236534
Case Number EO-2021228-000724
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name OUR BROTHERS KEEPER WELLNESS ORGANIZATION
Organization’s Mailing Address 7101 W 12TH STREET STE 200
City LITTLE ROCK
State AR
ZIP 72204
Accounting period End 12
Primary contact name TANYA MARYIE BELL BROOKS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LYNN WALLS
PRESIDENT
5 INNWOOD CIR
LITTLE ROSK AR 72211

Officer/Director/Trustee Two

MILES BROOKS
VICE PRESIDENT
315 OAK PARK DR
LITTLE ROCK AR 72204

Officer/Director/Trustee Three

TAMARA HARRIS
TREASURER
1000 GRAHAM AVE
NORTH LITTLE ROCK AR 72117

Officer/Director/Trustee Four

REDONIA HARSHAW
SECRETARY
7101 W 12TH STREET STE 200
LITTLE ROCK AR 72204

Officer/Director/Trustee Five

DORIS CLAY
BOARD MEMBER
6700 LANTANA
LITTLE ROCK AR 72209

Organization’s website OBKWELLNESS.ORG
Organization’s email OBKW@LIVE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/19/2007
Organization Incorporation State AR
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: 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 Yes
Unrelated Gross Income $1,000 or More Yes
Gaming Activity No
Disaster relief assistance Yes
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 MILES BROOKS
Signature Title VICE PRESIDENT
Signature Date 8/14/2021

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