FORM 1023-EZ for MACKINAC COUNTY WELLNESS COALITION

Field Data
EIN 84-1968315
Case Number EO-2019280-000330
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MACKINAC COUNTY WELLNESS COALITION
Organization’s Mailing Address PO BOX 61
City SAINT IGNACE
State MI
ZIP 49781
Accounting period End 9
Primary contact name SAMANTHA RADECKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SAMANTHA RADECKI
PRESIDENT AND SECRETARY
W1460 CHEESEMAN RD
SAINT IGNACE MI 49781

Officer/Director/Trustee Two

BETSY DAYRELL-HART
VICE PRESIDENT
49 SPRING ST
SAINT IGNACE MI 49781

Officer/Director/Trustee Three

ALYCIA MCKOWEN
TREASURER
301 LAFAYETTE AVE
PETOSKEY MI 49770

Officer/Director/Trustee Four

SUSAN KIRKMAN
TRUSTEE
3210 S WOODFIELD BLVD
SAULT STE. MARIE MI 49783

Officer/Director/Trustee Five

BETSY BABIONE
TRUSTEE
749 HOMBACH ST
SAINT IGNACE MI 49781

Organization’s website
Organization’s email SRADECKI@SAULTTRIBE.NET
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/27/19
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion 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 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 SAMANTHA RADECKI
Signature Title PRESIDENT AND SECRETARY
Signature Date 10/4/19

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