FORM 1023-EZ for MASSAGE RETREAT AND SPA FOUNDATION

Field Data
EIN 45-5359105
Case Number EO-2014303-000128
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MASSAGE RETREAT AND SPA FOUNDATION
Organization’s Mailing Address 4124 QUEBEC AVE SUITE 201
City NEW HOPE
State MN
ZIP 55427
Accounting period End 12
Primary contact name TRICIA ELMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PHIL BELDEN
DIRECTOR
2937 ORCHARD AVE N
GOLDEN VALLEY MN 55422

Officer/Director/Trustee Two

DON WAGNER
DIRECTOR
10107 BROOKSIDE CIR
BLOOMINGTON MN 55431

Officer/Director/Trustee Three

SHANE FLEMING
DIRECTOR
200 S SHORE CT
CHANHASSEN MN 55317

Officer/Director/Trustee Four

RANDY DALLMAN
DIRECTOR
10380 BUCKINGHAM DRIVE
EDEN PRAIRIE MN 55347

Officer/Director/Trustee Five

LEE OBERG
DIRECTOR
60 CARRIAGE LAND
BURNSVILLE MN 55306

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/21/2012
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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