FORM 1023-EZ for HENRY COUNTY MENTAL HEALTH ALLIANCENFP

Field Data
EIN 81-2567257
Case Number EO-2016138-000033
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HENRY COUNTY MENTAL HEALTH ALLIANCENFP
Organization’s Mailing Address 4424 US HIGHWAY 34
City KEWANEE
State IL
ZIP 61443
Accounting period End 12
Primary contact name BETH SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BETH SMITH
CHAIRPERSON
4424 US HIGHWAY 34
KEWANEE IL 61443

Officer/Director/Trustee Two

GAIL RIPKA
DIRECTOR
1322 KENT STREET
KEWANEE IL 61443

Officer/Director/Trustee Three

REBECCA MAGALHAES
DIRECTOR
6720 450 E STREET
NEPONSET IL 61345

Officer/Director/Trustee Four

DAVID HARRIS
DIRECTOR
12309 148 AVENUE
ORION IL 61723

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/8/2016
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
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 Yes
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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