FORM 1023-EZ for CENTENNIAL CARES

Field Data
EIN 61-1992563
Case Number EO-2021172-000386
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CENTENNIAL CARES
Organization’s Mailing Address 11910 WOODLAND PARKWAY NE
City BLAINE
State MN
ZIP 55449
Accounting period End 6
Primary contact name JENNIFER URBAN - CAF NO 0308-14263R
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SARA SHADY
PRESIDENT AND DIRECTOR
7669 PALOMINO LANE
LINO LAKES MN 55014

Officer/Director/Trustee Two

REBECCA THAMES-DRESDEN
TREASURER AND DIRECTOR
6706 TIMBERWOLF TRAIL
LINO LAKES MN 55014

Officer/Director/Trustee Three

HEATHER BERG-PATEL
SECRETARY AND DIRECTOR
11910 WOODLAND PARKWAY NE
BLAINE MN 55449

Officer/Director/Trustee Four

CRAIG ANDERSON
DIRECTOR
6186 TIMBERWOLF TRAIL
LINO LAKES MN 55014

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/13/2021
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code R30 - Intergroup, Race Relations
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 HEATHER BERG-PATEL
Signature Title SECRETARY AND DIRECTOR
Signature Date 6/17/2021

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