FORM 1023-EZ for NAMI WHITE MOUNTAINS AZ

Field Data
EIN 84-2034436
Case Number EO-2020101-000071
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NAMI WHITE MOUNTAINS AZ
Organization’s Mailing Address 20 E WHITE MT BLVD SUITE A5-164
City LAKESIDE
State AZ
ZIP 85929-0159
Accounting period End 12
Primary contact name LEROY JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RALPH ENGLER
PRESIDENT / DIRECTOR
20 E WHITE MT BLVD SUITE A5-164
LAKESIDE AZ 85929-0159

Officer/Director/Trustee Two

JULIE COTA
VP / DIRECTOR
20 E WHITE MT BLVD SUITE A5-164
LAKESIDE AZ 85929-0159

Officer/Director/Trustee Three

MAGGIE KRITCHER
SEC / DIRECTOR
20 E WHITE MT BLVD SUITE A5-164
LAKESIDE AZ 85929-0159

Officer/Director/Trustee Four

TINA CHEVALIER
TREASURER / DIRECTOR
20 E WHITE MT BLVD SUITE A5-164
LAKESIDE AZ 85929-0159

Officer/Director/Trustee Five

LEROY JOHNSON
DIRECTOR
20 E WHITE MT BLVD SUITE A5-164
LAKESIDE AZ 85929-0159

Organization’s website NAMIWMAZ.ORG
Organization’s email NAMIWHITEMOUNTAINS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/2/2019
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F99 - Mental Health, Crisis Intervention N.E.C.
Organization’s purpose Charitable: Yes
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 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 LEROY JOHNSON
Signature Title DIRECTOR
Signature Date 4/8/2020

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