FORM 1023-EZ for A TO Z MENTAL HEALTH SCHOLARSHIP FOUNDATION

Field Data
EIN 82-1948209
Case Number EO-2018059-000228
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name A TO Z MENTAL HEALTH SCHOLARSHIP FOUNDATION
Organization’s Mailing Address 480 WILLIAM AVE E
City DASSEL
State MN
ZIP 55325-1107
Accounting period End 12
Primary contact name NICOLE CARLEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NICOLE CARLEN
PRESIDENT
480 WILLIAM AVE E
DASSEL MN 55325-1107

Officer/Director/Trustee Two

JENNIFER ZANDER
VICE PRESIDENT
1403 126TH AVE NW
COON RAPIDS MN 55448

Officer/Director/Trustee Three

SARA KESKEY-RUFER
TREASURER
PO BOX 366
COKATO MN 55321

Officer/Director/Trustee Four

KERI BUSH
MEMBER
5523 COUNTY ROAD 8 SW
WAVERLY MN 55390

Officer/Director/Trustee Five

NICOLE KESKEY
MEMBER
8098 COUNTY ROAD 3 SW
COKATO MN 55321

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/19/17
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 Yes
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 NICOLE CARLEN
Signature Title PRESIDENT
Signature Date 2/26/18

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