FORM 1023-EZ for MENTAL HEALTH ADVOCACY INC

Field Data
EIN 46-1743631
Case Number EO-2015033-000303
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MENTAL HEALTH ADVOCACY INC
Organization’s Mailing Address PO BOX 26952
City RALEIGH
State NC
ZIP 27611
Accounting period End 6
Primary contact name MARC JACQUES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GENE COOK
PRESIDENT
17144 GRISSOM RD
ORLANDO FL 32833

Officer/Director/Trustee Two

KENT EARNHARDT
VICE PRESIDENT
311 STONEY MOSS DRIVE
RALEIGH NC 27610

Officer/Director/Trustee Three

LUCY WILMER
TREASURER
806 GRIMES ROAD
WASHINGTON NC 27889

Officer/Director/Trustee Four

JIM PERRY
DIRECTOR
PO BOX 26952
RALEIGH NC 27611

Officer/Director/Trustee Five

JAMES BOUWKNEGT
DIRECTOR
PO BOX 26952
RALEIGH NC 27611

Organization’s website WWW.MENTALHEALTHADVOCACYINC.ORG
Organization’s email MARCJACQUES@MENTALHEALTHADVOCACYINC.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/5/2012
Organization Incorporation State NC
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 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
Signature Title
Signature Date

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