FORM 1023-EZ for THE SHEPHERDS WELL

Field Data
EIN 84-4066028
Case Number EO-2019360-000395
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE SHEPHERDS WELL
Organization’s Mailing Address PO BOX 346
City LAGRANGE
State OH
ZIP 44050-9706
Accounting period End 12
Primary contact name JANE I CAWLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JANE CAWLEY
CHIEF EXECUTIVE OFFICER
PO BOX 346
LAGRANGE OH 44050-9706

Officer/Director/Trustee Two

SARAH CAWLEY
CHIEF FINANACIAL OFFICER
PO BOX 346
LAGRANGE OH 44050-9706

Officer/Director/Trustee Three

SHERRI SWANN
VOTING BOARD MEMBER
PO BOX 346
LAGRANGE OH 44050-9706

Officer/Director/Trustee Four

SHAWNDA BOYSEL
VOTING BOARD MEMBER
PO BOX 346
LAGRANGE OH 44050-9706

Officer/Director/Trustee Five

KATHY ZENTNER
VOTING BOARD MEMBER
PO BOX 346
LAGRANGE OH 44050-9706

Organization’s website WWW.SHEPHERDSWELL.ORG
Organization’s email THESHEPHERDSWELL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/17/2019
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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 JANE CAWLEY
Signature Title CHIEF EXECUTIVE OFFICER
Signature Date 12/24/2019

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