FORM 1023-EZ for PETRA TRANSITIONAL HOUSING INC

Field Data
EIN 86-3035277
Case Number EO-2021104-000128
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PETRA TRANSITIONAL HOUSING INC
Organization’s Mailing Address 12856 MANKATO STREET NORTHEAST
City BLAINE
State MN
ZIP 55449
Accounting period End 12
Primary contact name ELIZABETH FLECK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ELIZABETH FLECK
FOUNDER
12856 MANKATO STREET NORTHEAST
BLAINE MN 55449

Officer/Director/Trustee Two

CHURCHIMA NGOMA
DIRECTOR
12091 64TH ST NE
ALBERTVILLE MN 55449

Officer/Director/Trustee Three

BECKY VLACK
DIRECTOR
6628 CLARKIA DR NW
ROCHESTER MN 55901

Officer/Director/Trustee Four

ISAAC KWESON
DIRECTOR
12211 JAY STREET
COON RAPIDS MN 55448

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/5/2021
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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 Yes
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 ELIZABETH FLECK
Signature Title FOUNDER
Signature Date 4/7/2021

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