FORM 1023-EZ for NAMI MID CENTRAL ILLINOIS

Field Data
EIN 83-1177854
Case Number EO-2018194-000088
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NAMI MID CENTRAL ILLINOIS
Organization’s Mailing Address 506 ARROWHEAD
City HEYWORTH
State IL
ZIP 61745
Accounting period End 6
Primary contact name BECKY LONGSTRETH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NEAL IDEN
PRESIDENT
1107 WINSTON CT
NORMAL IL 61761

Officer/Director/Trustee Two

COLLEEN OCONNOR
EXECUTIVE DIRECTOR
1002 1/2 E WASHINGTON STREET A
BLOOMINGTON IL 61701

Officer/Director/Trustee Three

BECKY LONGSTRETH
TREASURER
506 ARROWHEAD
HEYWORTH IL 61745

Officer/Director/Trustee Four

KOLTON MOOBERRY
VICE PRESIDENT
703 TURNBERRY DR APT B
BLOOMINGTON IL 61701

Officer/Director/Trustee Five

TOSHA MAAKS
BOARD MEMBER
201 E BOUNDARY ST
STANDFORD IL 61774

Organization’s website WWW.NAMILIVINGSTONMCLEAN.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/9/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 BECKY LONGSTRETH
Signature Title TREASURER
Signature Date 7/10/18

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