FORM 1023-EZ for SHIELDS INITIATIVE

Field Data
EIN 81-3932698
Case Number EO-2017289-000405
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SHIELDS INITIATIVE
Organization’s Mailing Address 3007 WOODLAWN DR
City PARMA
State OH
ZIP 44134
Accounting period End 12
Primary contact name TERRY DOBRANSKY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERRY DOBRANSKY
PRESIDENT, DIRECTOR
3007 WOODLAWN DR
PARMA OH 44134

Officer/Director/Trustee Two

WILLIAM RANDALL IV
SECRETARY, DIRECTOR
5508 SUPERIOR AVE
CLEVELAND OH 44103

Officer/Director/Trustee Three

KEVIN HERIDAN
TREASURER, DIRECTOR
534 WEST MAIN ST
RAVENNA OH 44266

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/19/2016
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 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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