FORM 1023-EZ for FAITH-BASED MENTAL HEALTH INITIATIVE
| Field | Data |
|---|---|
| EIN | 85-3443462 |
| Case Number | EO-2021027-000331 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | FAITH-BASED MENTAL HEALTH INITIATIVE |
| Organization’s Mailing Address | 3619 PANTHERSVILLE ROAD |
| City | DECATUR |
| State | GA |
| ZIP | 30034 |
| Accounting period End | 12 |
| Primary contact name | DORCAS JAMISON |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
CHARLENE FLAGG
PRESIDENT
1226 ROYAL DRIVE
CONYERS GA 30094
Officer/Director/Trustee Two
HERMAN HAYNES
VICE-PRESIDENT
2588 CLIFONT SPRINGS ROAD
DECATUR GA 30034
Officer/Director/Trustee Three
DEBRA HANSON
SECRETARY
997 COMMERCIE DR SW STE 3A
CONYERS GA 30094
Officer/Director/Trustee Four
BRYAN JONES
TREASURER
4000 BRANTLEY DRIVE
AUSTELL GA 30106
| Organization’s website | HTTPS://WWW.FAITHBASEDMENTALHEALTH.ORG |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 10/15/2020 |
| Organization Incorporation State | GA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | F30 - Mental Health Treatment - Multipurpose and N.E.C. |
| Organization’s purpose | Charitable: Yes Religious: Yes 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 | 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 | No |
| One Third Support Public | No |
| One Third Support Gifts | No |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | CHARLENE FLAGG |
| Signature Title | PRESIDENT |
| Signature Date | 12/4/2020 |
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