FORM 1023-EZ for LEGISLATIVE BREAKFAST ON MENTAL HEALTH

Field Data
EIN 83-2409654
Case Number EO-2019343-000196
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LEGISLATIVE BREAKFAST ON MENTAL HEALTH
Organization’s Mailing Address 3107 SOUTH ELM-EUGENE STREET
City GREENSBORO
State NC
ZIP 27406
Accounting period End 12
Primary contact name JACQUELINE STANLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER GADD
PRESIDENT
2409 WOOD DUCK DRIVE
GRAHAM NC 27253

Officer/Director/Trustee Two

MAX SHAFIR
SECRETARY
8320 HARDETH WAY
RALEIGH NC 27616

Officer/Director/Trustee Three

LINDA FOXWORTH
VICE PRESIDENT
103 WOODSHIRE LANE
CHAPEL HILL NC 27516

Officer/Director/Trustee Four

KAREN KINCAID DUNN
TREASURER - CO CHAIR
8729 DREW LANE
CHAPEL HILL NC 27516

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/27/2018
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 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 JENNIFER GADD
Signature Title PRESIDENT
Signature Date 12/5/2019

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