FORM 1023-EZ for MENTORSHIP AND PEER SUPPORT OF NH

Field Data
EIN 86-2567371
Case Number EO-2021109-000135
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MENTORSHIP AND PEER SUPPORT OF NH
Organization’s Mailing Address 2 CASS STREET
City EXETER
State NH
ZIP 03833
Accounting period End 12
Primary contact name NICHOLAS CUSHMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STACY GILLIS
PRESIDENT
2 CASS STREET
EXETER NH 03833

Officer/Director/Trustee Two

DIANA HEBERT
VICE PRESIDENT
48 GROVE STREET
SPRINGFIELD VT 05156

Officer/Director/Trustee Three

NICHOLAS CUSHMAN
TRESURER
18 ROCKINGHAM POST ROAD
ROCKINGHAM VT 05101

Officer/Director/Trustee Four

ELLEN LEAVITT-GROSSMAN
SECRETARY
309 EASTVIEW DRIVE
WILTON NH 03086

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/11/2021
Organization Incorporation State NH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E50 - Rehabilitative Medical Services
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 Yes
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 NICHOLAS CUSHMAN
Signature Title TRESURER
Signature Date 4/15/2021

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