FORM 1023-EZ for NAMI BLUE RIDGE CHARLOTTESVILLE INC

Field Data
EIN 54-1371866
Case Number EO-2018051-000439
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NAMI BLUE RIDGE CHARLOTTESVILLE INC
Organization’s Mailing Address 134 SADDLE RIDGE LN
City NELLYSFORD
State VA
ZIP 22958
Accounting period End 12
Primary contact name MICHAEL W KELLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL KELLEY
PRESIDENT
134 SADDLE RIDGE LN
NELLYSFORD VA 22958

Officer/Director/Trustee Two

SUZANNA MALM
VICE PRESIDENT
5802 JEFFERSON MILL RD
SCOTTSVILLE VA 24590

Officer/Director/Trustee Three

MARTHA DEJARNETTE
SECRETARY
1804 BRENDA CT
CHARLOTTESVILLE VA 22901

Officer/Director/Trustee Four

CONNIE MATERNICK
TREASURER
681 BOWLES MILL RN
GORDONSVILLE VA 22942

Organization’s website WWW.NAMIBLUERIDGECHARLOTTESVILLE.ORG
Organization’s email NAMIBLUERIDGE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/24/85
Organization Incorporation State VA
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MICHAEL KELLEY
Signature Title PRESIDENT
Signature Date 2/17/18

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