FORM 1023-EZ for ELGIN - MILLVILLE EMS INC

Field Data
EIN 30-0115723
Case Number EO-2015002-000279
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ELGIN - MILLVILLE EMS INC
Organization’s Mailing Address PO BOX 207
City ELGIN
State MN
ZIP 55932
Accounting period End 12
Primary contact name MATTHEW JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TIMOTHY WINKELS
CHAIR
255 1ST AVE NE
ORONOCO MN 55960

Officer/Director/Trustee Two

MICHAEL ZARLING
VICE CHAIR
4709 15TH AVE NW
ROCHESTER MN 55901

Officer/Director/Trustee Three

DEBRA CRARY
PRESIDENT
107 6TH AVE NE
ELGIN MN 55932

Officer/Director/Trustee Four

HEATHER BOWDEN
SECRETARY
106 6TH AVE NE
ELGIN MN 55932

Officer/Director/Trustee Five

DAVID KOHS
TREASURER
107 6TH AVE NE
ELGIN MN 55932

Organization’s website
Organization’s email ELGINEMS@HBCI.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/18/2000
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E62 - Ambulance, Emergency Medical Transport Services
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 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
Signature Title
Signature Date

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