FORM 1023-EZ for GLIA MENTAL HEALTH

Field Data
EIN 47-5327786
Case Number EO-2016004-000266
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GLIA MENTAL HEALTH
Organization’s Mailing Address 12915 BERKHAMSTED STREET
City CERRITOS
State CA
ZIP 90703-9376
Accounting period End 12
Primary contact name PRATIK DOSHI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PRATIK DOSHI
FOUNDER AND CEO
12915 BERKHAMSTED STREET
CERRITOS CA 90703-9376

Officer/Director/Trustee Two

JUHEE SHAH
VICE PRESIDENT
18800 HORST AVENUE
ARTESIA CA 90702-1140

Officer/Director/Trustee Three

SIVAKAMI ANANTHASINGAM
VICE PRESIDENT
19 LINDA COURT
STATEN ISLAND CA 10302-1735

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/4/2015
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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
Signature Title
Signature Date

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