FORM 1023-EZ for MENTAL HEALTH USA

Field Data
EIN 82-3266637
Case Number EO-2017320-000412
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MENTAL HEALTH USA
Organization’s Mailing Address 7899 GRANT CREEK RD NW
City BEMIDJI
State MN
ZIP 56601-9261
Accounting period End 12
Primary contact name VALERIE J SAVIANO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VALERIE J SAVIANO
PRESIDENT
7899 GRANT CREEK RD NW
BEMIDJI MN 56601-9261

Officer/Director/Trustee Two

RUSSELL L COCKRUM
TREASURER
55 CRAMER PL
MARTINSVILLE IN 46151-1328

Officer/Director/Trustee Three

TODD O JOHNSON
DIRECTOR
5378 DIERKS DR
ROCKFORD IL 61108-8095

Organization’s website WWW.MENTALHEALTHUSA.ORG
Organization’s email VALERIES@MENTALHEALTHUSA.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/17/2017
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F99 - Mental Health, Crisis Intervention N.E.C.
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 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
Signature Title
Signature Date

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