FORM 1023-EZ for POEMSS CLINIC WELLNESS CENTER

Field Data
EIN 82-4712909
Case Number EO-2018117-000073
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POEMSS CLINIC WELLNESS CENTER
Organization’s Mailing Address 4332 BROOKSIDE AVE
City ST LOUIS PARK
State MN
ZIP 55436-1506
Accounting period End 12
Primary contact name KEVIN KRUSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEVIN KRUSE
CHAIR OF BOARD
4332 BROOKSIDE AVE
ST. LOUIS PARK MN 55436-1506

Officer/Director/Trustee Two

STACEY FINNEGAN
SECRETARY OF BOARD
5664 W36TH STREET
ST. LOUIS PARK MN 55416-2618

Officer/Director/Trustee Three

CHRIS CALLAHAN
TREASURER OF BOARD
20036 HERITAGE DRIVE
LAKEVILLE MN 55044-9226

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/8/18
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support 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 Yes
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 KEVIN KRUSE
Signature Title CHAIR OF BOARD
Signature Date 4/25/18

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