FORM 1023-EZ for WELL4LAKECOUNTY

Field Data
EIN 85-2246276
Case Number EO-2020216-000230
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WELL4LAKECOUNTY
Organization’s Mailing Address 259 SPRING VALLEY WAY
City ROUND LAKE
State IL
ZIP 60073-9543
Accounting period End 12
Primary contact name WILLIAM GENTES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRUCE JOHNSON
OFFICER
416 SOUTH GROVE
BARRINGTON IL 60010

Officer/Director/Trustee Two

MIKE NERHEIM
OFFICER
34959 NORTH OAK KNOLL CIRCLE
GURNEE IL 60031

Officer/Director/Trustee Three

WILLIAM GENTES
CHAIRMAN
259 SPRING VALLEY WAY
ROUND LAKE IL 60073

Organization’s website
Organization’s email WGENTES@DRUGFREELAKECOUNTY.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/30/2020
Organization Incorporation State IL
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 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 WILLIAM GENTES
Signature Title CHAIRMAN
Signature Date 7/30/2020

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