FORM 1023-EZ for MHA OF GREATER AUGUSTA1

Field Data
EIN 58-0837305
Case Number EO-2017017-000528
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MHA OF GREATER AUGUSTA1
Organization’s Mailing Address 1720 CENTRAL AVE
City AUGUSTA
State GA
ZIP 30904
Accounting period End 12
Primary contact name LEONARD C MAXEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LEONARD MAXEY
DIRECTOR
1720 CENTRAL AVE
AUGUSTA GA 30904

Officer/Director/Trustee Two

SCOTT PEEBLES
PRESIDENT
212 NEWLAND CIRCLE
EVANS GA 30809

Officer/Director/Trustee Three

DAWN PEEBLES
VICE PRESIDENT
212 NEWLAND CIRCLE
EVANS GA 30809

Officer/Director/Trustee Four

STEVE HOBBS
TREASURER
669 ROCKBROOK LANE
NORTH AUGUSTA SC 29841

Organization’s website HTTP://WWW.MENTALHEALTHAUGUSTA.ORG/
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/13/1976
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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