FORM 1023-EZ for MOUNTAIN MENTAL HEALTH

Field Data
EIN 84-2129768
Case Number EO-2020009-000222
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MOUNTAIN MENTAL HEALTH
Organization’s Mailing Address 40680 HIGHWAY 41 SUITE D
City OAKHURST
State CA
ZIP 93644-9657
Accounting period End 6
Primary contact name CAROL E
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CAROL WINDSOR
CHIEF EXECUTIVE OFFICER
38607 BIRCH CIRCLE
OAKHURST CA 93644

Officer/Director/Trustee Two

JESSICA OBERLIN
SECRETARY
40304 ROAD 222
BASS LAKE CA 93604

Officer/Director/Trustee Three

BRYAN KING
CHIEF FINANCIAL OFFICER
38607 BIRCH CIRCLE
OAKHURST CA 93644

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/12/2019
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 Yes
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 CAROL WINDSOR
Signature Title CHIEF EXECUTIVE OFFICER
Signature Date 1/6/2020

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