FORM 1023-EZ for BEHAVIORAL HEALTH INSTITUTE OF MONMOUTH COUNTY

Field Data
EIN 81-2082284
Case Number EO-2016138-000050
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BEHAVIORAL HEALTH INSTITUTE OF MONMOUTH COUNTY
Organization’s Mailing Address 37 VILLAGE CT
City HAZLET
State NJ
ZIP 07730-3222
Accounting period End 12
Primary contact name SCOTT ROZEK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DEIRDRE WATERS
PRESIDENT
37 VILLAGE CT
HAZLET NJ 07730-3222

Officer/Director/Trustee Two

SCOTT ROZEK
VICE PRESIDENT
37 VILLAGE CT
HAZLET NJ 07730-3222

Officer/Director/Trustee Three

THERESA WATERS
SECRETARY
10 GARDEN ST
MONTCLAIR NJ 07042

Organization’s website
Organization’s email BEHAVIORALHEALTHINSTITUTE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/3/2016
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F30 - Mental Health Treatment - Multipurpose and N.E.C.
Organization’s purpose Charitable: Yes
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
Signature Title
Signature Date

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