FORM 1023-EZ for DRAGONFLY MENTAL HEALTH

Field Data
EIN 85-3349667
Case Number EO-2021023-000009
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DRAGONFLY MENTAL HEALTH
Organization’s Mailing Address 1585 62ND STREET SUITE 99676
City EMERYVILLE
State CA
ZIP 94608
Accounting period End 12
Primary contact name ANDREW MORTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WENDY INGRAM
PRESIDENT
1585 62ND STREET SUITE 99676
EMERYVILLE CA 94608

Officer/Director/Trustee Two

SEAN BUDDE
TREASURER/DIRECTOR
1585 62ND STREET SUITE 99676
EMERYVILLE CA 94608

Officer/Director/Trustee Three

KEVIN FRICK
SECRETARY/DIRECTOR
1585 62ND STREET SUITE 99676
EMERYVILLE CA 94608

Officer/Director/Trustee Four

DEIRDRE BYRNE
DIRECTOR
1585 62ND STREET SUITE 99676
EMERYVILLE CA 94608

Officer/Director/Trustee Five

RAYMOND DEPAULO
DIRECTOR
1585 62ND STREET SUITE 99676
EMERYVILLE CA 94608

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/27/2020
Organization Incorporation State CA
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: 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 Yes
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 No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name WENDY INGRAM
Signature Title PRESIDENT
Signature Date 12/6/2020

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