FORM 1023-EZ for OHIO BEHAVIORAL WELLNESS AGENCY

Field Data
EIN 85-3247986
Case Number EO-2020308-000122
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name OHIO BEHAVIORAL WELLNESS AGENCY
Organization’s Mailing Address 12805 REVERE AVE
City CLEVELAND
State OH
ZIP 44105
Accounting period End 12
Primary contact name JEFFERY WARD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEFFERY WARD
PRESIDENT
12805 REVERE AVE
CLEVELAND OH 44105

Officer/Director/Trustee Two

CELESTE WARD
SECRETARY
12805 REVERE AVE
CLEVELAND OH 44105

Officer/Director/Trustee Three

WILLIAM WARREN
DIRECTOR
12805 REVERE AVE
CLEVELAND OH 44105

Officer/Director/Trustee Four

SARA BROWN
TREASURER
6705 CHINKAPIN CT
BEDFORD OH 44146

Officer/Director/Trustee Five

HENRY GREEN
DIRECTOR
4075 MONTICELLO AVE
CLEVELAND HEIGHTS OH 44121

Organization’s website
Organization’s email SBCDPS509@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/14/2020
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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 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 JEFFERY WARD
Signature Title PRESIDENT
Signature Date 11/1/2020

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