FORM 1023-EZ for THE PENNSYLVANIA MENTAL HEALTH INITIATIVE
| Field | Data |
|---|---|
| EIN | 83-0926359 |
| Case Number | EO-2020027-000330 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | THE PENNSYLVANIA MENTAL HEALTH INITIATIVE |
| Organization’s Mailing Address | 3010 WELLS TERRACE |
| City | STATE COLLEGE |
| State | PA |
| ZIP | 16801 |
| Accounting period End | 12 |
| Primary contact name | PHILIP J BURLINGAME |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
PHILIP BURLINGAME
EXECUTIVE DIRECTOR
3010 WELLS TERRACE
STATE COLLEGE PA 16801
Officer/Director/Trustee Two
ERIC CROWN
BOARD PRESIDENT
3010 WELLS TERRACE
STATE COLLEGE PA 16801
Officer/Director/Trustee Three
THOMAS KISTLER
BOARD VICE PRESIDENT
3010 WELLS TERRACE
STATE COLLEGE PA 16801
Officer/Director/Trustee Four
JANET SANTOSTEFANO
BOARD TREASURER
3010 WELLS TERRACE
STATE COLLEGE PA 16801
Officer/Director/Trustee Five
GWEN AUMAN
BOARD SECRETARY
3010 WELLS TERRACE
STATE COLLEGE PA 16801
| Organization’s website | N/A |
|---|---|
| Organization’s email | PJBURLINGAME@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 5/22/2018 |
| Organization Incorporation State | PA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | F01 - Alliance/Advocacy Organizations |
| 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 | PHILIP BURLINGAME |
| Signature Title | EXECUTIVE DIRECTOR |
| Signature Date | 1/23/2020 |
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