FORM 1023-EZ for MENTAL HEALTH AMERICA OF KERSHAW COUNTY

Field Data
EIN 57-0646317
Case Number EO-2015082-000316
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MENTAL HEALTH AMERICA OF KERSHAW COUNTY
Organization’s Mailing Address PO BOX 586 110 EAST DEKALB STREET
City CAMDEN
State SC
ZIP 29020-2028
Accounting period End 12
Primary contact name DEBORAH MASSALON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DEBORAH MASSALON
EXECUTIVE DIRECTOR
2109 FOREST DRIVE
CAMDEN SC 29020-2025

Officer/Director/Trustee Two

LARRY GRAHAM
CHAIRMAN
804 LYNN AVEUNE
CAMDEN SC 29020-2025

Officer/Director/Trustee Three

KATHY BARNES
SECRETARU
412 RIDGECREST DRIVE
CAMDEN SC 29020-2025

Officer/Director/Trustee Four

DALE SHEHEEN
PAST CHAIR
205 CHRISTMAS PLACE
CAMDEN SC 29020-2025

Officer/Director/Trustee Five

OLLIE THOMPSON
TREASURER
31 LEE ROAD
CAMDEN SC 29020-2025

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/20/1971
Organization Incorporation State SC
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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