FORM 1023-EZ for REAL EMPOWERMENT COLLABORATIVE

Field Data
EIN 82-5102398
Case Number EO-2018101-000412
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name REAL EMPOWERMENT COLLABORATIVE
Organization’s Mailing Address 290 LAUREL ROAD
City MAHTOMEDI
State MN
ZIP 55115-1424
Accounting period End 12
Primary contact name ADAM MOEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ADAM MOEN
DIRECTOR, BOARD CHAIR
290 LAUREL ROAD
MAHTOMEDI MN 55115-1424

Officer/Director/Trustee Two

DAVID MOEN
BOARD MEMBER
290 LAUREL ROAD
MAHTOMEDI MN 55115-1424

Officer/Director/Trustee Three

KAREN MOEN
BOARD MEMBER
290 LAUREL ROAD
MAHTOMEDI MN 55115-1424

Organization’s website REPCOLLAB.ORG
Organization’s email ADAM@REPTECH.IO
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/9/18
Organization Incorporation State MN
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: Yes
Scientific: Yes
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More Yes
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ADAM MOEN
Signature Title DIRECTOR, BOARD CHAIR
Signature Date 4/9/18

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