FORM 1023-EZ for OUR MENTAL ILLNESS INC

Field Data
EIN 83-3437952
Case Number EO-2019149-000144
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name OUR MENTAL ILLNESS INC
Organization’s Mailing Address 409 EAST 5TH ST
City NEILLSVILLE
State WI
ZIP 54456
Accounting period End 12
Primary contact name CHAD SCHOEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHAD SCHOEN
PRESIDENT/TREASURER
409 EAST 5TH ST
NEILLSVILLE WI 54456

Officer/Director/Trustee Two

BERYL PETERSON
SECRETARY
N904 CLARK AVE
NEILLSVILLE WI 54456

Officer/Director/Trustee Three

DONNA LARSON
BOARD MEMBER
395 HOLLY CT
PRAIRE DU SAC WI 53578

Officer/Director/Trustee Four

RENEE CONLEY
BOARD MEMBER
395 HOLLY CT
PRAIRE DU SAC WI 53578

Organization’s website HTTPS://WWW.OUR-MENTAL-ILLNESS.ORG
Organization’s email CHAD@OUR-MENTAL-ILLNESS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/4/19
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
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 Yes
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 CHAD SCHOEN
Signature Title PRESIDENT/TREASURER
Signature Date 5/27/19

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