FORM 1023-EZ for VETERANS ADVISORY COMMITEE ON MENTAL HEALTH

Field Data
EIN 47-2823001
Case Number EO-2015049-000012
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name VETERANS ADVISORY COMMITEE ON MENTAL HEALTH
Organization’s Mailing Address VAMCSLC 500 FOOTHILL DRIVE BLDG 16
City SALT LAKE CITY
State UT
ZIP 84148
Accounting period End 12
Primary contact name NOELLE H SKILTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT CLIZBE
CHAIRMAN
589 ONINO
ELKO NV 89801

Officer/Director/Trustee Two

IVONNE MOORE
VICE-CHAIRMAN
3665 S 5200 WEST
WEST VALLEY CITY UT 84120

Officer/Director/Trustee Three

JAMES MANSFIELD
SECRETARY
2246 E ROSEVELT AVE
SALT LAKE CITY UT 84108

Officer/Director/Trustee Four

IRENE WALLINGFORD
SERGEANT AT ARMS
1899 E 7130 SOUTH
SALT LAKE CITY UT 84121

Officer/Director/Trustee Five

NOELLE SKILTON
CONSULTANT
1291 FOXCREST COURT
PARK CITY UT 84098

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/28/2009
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
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 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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