FORM 1023-EZ for COMMUNITY PARTNERSHIPS FOR MENTAL HEALTH

Field Data
EIN 81-5085630
Case Number EO-2017052-000192
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COMMUNITY PARTNERSHIPS FOR MENTAL HEALTH
Organization’s Mailing Address PO BOX 1056 365 WEST THIRD AVENUE
City KETTLE FALLS
State WA
ZIP 99141
Accounting period End 12
Primary contact name LETA PHILLIPS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LETA PHILLIPS
PRESIDENT
365 WEST THIRD AVENUE
KETTLE WA 99141

Officer/Director/Trustee Two

PEGGY MANDIN
VICE PRESIDENT
3391 ROCKCUT ROAD
KETTLE FALLS WA 99141

Officer/Director/Trustee Three

STEPHEN GRAY
TREASURER
3293 CHINA BEND ROAD
KETTLE FALLS WA 99141

Officer/Director/Trustee Four

ADAM JESSEE
SECRETARY
180 EAST 10TH STREET
KETTLE FALLS WA 99141

Officer/Director/Trustee Five

JACOB LEVEL
BOARD MEMBER
344 NORTH MAIN STREET
COLVILLE WA 99114

Organization’s website
Organization’s email PARTNERSHIPSFORMENTALHELATH@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/8/2013
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
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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