FORM 1023-EZ for NORTH COUNTRY WELLNESS

Field Data
EIN 83-3997512
Case Number EO-2019143-000174
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NORTH COUNTRY WELLNESS
Organization’s Mailing Address 3660 40TH AVE S
City MINNEAPOLIS
State ME
ZIP 55406-2847
Accounting period End 12
Primary contact name NIA SOPIWNIK STEWART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NIA SOPIWNIK STEWART
PRESIDENT
3660 40TH AVE S
MINNEAPOLIS MN 55406-2847

Officer/Director/Trustee Two

EMILY WARREN
VICE PRESIDENT
342 W 29TH ST
BALTIMORE MD 21211

Officer/Director/Trustee Three

JESSICA CINTORINO
TREASURER
1907 PIERCE ST
MINNEAPOLIS MN 55418

Officer/Director/Trustee Four

LEIGH GRAUMAN
SECRETARY
3700 40TH AVE S
MINNEAPOLIS MN 55406-2847

Officer/Director/Trustee Five

ERIN HOFFMAN
CHIEF EXECUTIVE OFFICER
1600 EDMUND AVE
ST PAUL MN 55104

Organization’s website WWW.NORTHCOUNTRYWELLNESS.ORG
Organization’s email NIA.STEWART@NORTHCOUNTRYWELLNESS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/11/18
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F30 - Mental Health Treatment - Multipurpose and 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 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name NIA SOPIWNIK STEWART
Signature Title PRESIDENT
Signature Date 5/20/19

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