FORM 1023-EZ for COMMUNITY BEHAVIORAL HEALTH INC

Field Data
EIN 82-2891051
Case Number EO-2021132-000347
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY BEHAVIORAL HEALTH INC
Organization’s Mailing Address 534 S KANSAS AVE SUITE 330
City TOPEKA
State KS
ZIP 66603-3451
Accounting period End 6
Primary contact name MICHELLE PONCE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RANDY CALLSTROM
PRESIDENT
534 S KANSAS SUITE 330
TOPEKA KS 66603-3451

Officer/Director/Trustee Two

BRENDA MILLS
TREASURER
534 S KANSAS AVE SUITE 330
TOPEKA KS 66603-3451

Officer/Director/Trustee Three

KYLE KESSLER
SECRETARY
534 S KANSAS AVE SUITE 330
TOPEKA KS 66603-3451

Officer/Director/Trustee Four

MATT ATTEBERRY
BOARD MEMBER
534 S KANSAS AVE SUITE 330
TOPEKA KS 66603-3451

Officer/Director/Trustee Five

GREG HENNEN
BOARD MEMBER
534 S KANSAS AVE SUITE 330
TOPEKA KS 66603-3451

Organization’s website NA
Organization’s email MPONCE@ACMHCK.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/12/2017
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F02 - Management & Technical Assistance
Organization’s purpose Charitable: No
Religious: No
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name KYLE KESSLER
Signature Title SECRETARY
Signature Date 5/10/2021

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