FORM 1023-EZ for POLITICS AND HEALTHCARE FORUM

Field Data
EIN 46-1064769
Case Number EO-2015247-000184
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name POLITICS AND HEALTHCARE FORUM
Organization’s Mailing Address 12000 ELM CREEK BLVD N SUITE 300
City MAPLE GROVE
State MN
ZIP 55369
Accounting period End 12
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 $400.00
Officer/Director/Trustee One

STEVEN TROBIANI
PRESIDENT + DIRECTOR
12000 ELM CREEK BLVD N SUITE 300
MAPLE GROVE MN 55369

Officer/Director/Trustee Two

STARR-CARA MCMILLEN
SECRETARY + DIRECTOR
366 NATHAN LN N
CHAMPLIN MN 55316

Officer/Director/Trustee Three

MICHAEL WILLIAMS
TREASURER + DIRECTOR
787 LAUREL AVE
ST PAUL MN 55401

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/26/2012
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
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 Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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