FORM 1023-EZ for NATIONAL ALLIANCE ON MENTAL ILLNESSOF NORTH IOWA

Field Data
EIN 47-2728148
Case Number EO-2015012-000543
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NATIONAL ALLIANCE ON MENTAL ILLNESSOF NORTH IOWA
Organization’s Mailing Address 13 N FEDERAL
City MASON CITY
State IA
ZIP 50401
Accounting period End 12
Primary contact name TIM SCHUPICK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOAN SUNDE
PRESIDENT, DIRECTOR
27 PARK LANE
CLEAR LAKE IA 50428

Officer/Director/Trustee Two

ANDREA MUJICA
TREASURER
1452 7TH ST SE
MASON CITY IA 50401

Officer/Director/Trustee Three

SHELENE CODNER
SECRETARY, DIRECTOR
16764 CLAY AVE
DUMONT IA 50265

Officer/Director/Trustee Four

DEE HUNT
VICE PRES., DIRECTOR
23050 - 295TH ST
NORA SPRINGS IA 50458

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/1/2010
Organization Incorporation State IA
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 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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