FORM 1023-EZ for OPEN MIND NEUROSURGICAL INTERNATIONAL

Field Data
EIN 26-1225151
Case Number EO-2015146-000351
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name OPEN MIND NEUROSURGICAL INTERNATIONAL
Organization’s Mailing Address 205 DE ANZA BOULEVARD SUITE 112
City SAN MATEO
State CA
ZIP 94402
Accounting period End 12
Primary contact name SCOTT BERTA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DALE HAMBLIN
PRESIDENT
2783 BECHELLI LANE
REDDING CA 96002

Officer/Director/Trustee Two

BREANNA SCOTT
SECRETARY
2783 BECHELLI LANE
REDDING CA 96002

Officer/Director/Trustee Three

NANCY WANG
TREASURER
2783 BECHELLI LANE
REDDING CA 96002

Organization’s website OPENMINDMD.ORG
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2010
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 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 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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