FORM 1023-EZ for TRIPLE WILLOW MENTAL HEALTH CLINIC INC

Field Data
EIN 82-2633742
Case Number EO-2017265-000155
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TRIPLE WILLOW MENTAL HEALTH CLINIC INC
Organization’s Mailing Address 7308 HANOVER GREEN DRIVE SUITE 300
City MECHANICSVILLE
State VA
ZIP 23111-1793
Accounting period End 12
Primary contact name KYLE DON MCCALL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KYLE DON MCCALL
PRESIDENT
7308 HANOVER GREEN DRIVE SUITE 300
MECHANICSVILLE VA 23111-1793

Officer/Director/Trustee Two

MELINDA KAY MCCALL
TREASURER
7308 HANOVER GREEN DRIVE SUITE 300
MECHANICSVILLE VA 23111-1793

Officer/Director/Trustee Three

ADAM MOORE MCCALL
SECRETARY
7308 HANOVER GREEN DRIVE SUITE 300
MECHANICSVILLE VA 23111-1793

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/23/2017
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - 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 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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