FORM 1023-EZ for MINNESOTA DBT PROVIDERS COALITION

Field Data
EIN 83-3630602
Case Number EO-2019059-000375
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MINNESOTA DBT PROVIDERS COALITION
Organization’s Mailing Address 8646 EAGLE CREEK PARKWAY SUITE 213
City SAVAGE
State MN
ZIP 55378
Accounting period End 12
Primary contact name JACQUELINE STRATTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JACQUELINE STRATTON
FOUNDER
8646 EAGLE CREEK PARKWAY SUITE 213
SAVAGE MN 55378

Officer/Director/Trustee Two

SARAH STELZNER
CHAIR
3737 40TH AVE NW
ROCHETER MN 55901

Officer/Director/Trustee Three

MANDY HYLAND
VICE CHAIR
3737 40TH AVE NW
ROCHESTER MN 55901

Officer/Director/Trustee Four

MICHAEL MILLER
TREASURER
1595 SHELBY AVE SUITE 210
ST. PAUL MN 55104

Officer/Director/Trustee Five

SUSAN VOSS
SECERTARY
3300 COUNTRY ROAD 10 SUITE 500
BROOKLYN CENTER MN 55429

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/25/18
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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 No
Donation of funds Yes
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SARAH STELZNER
Signature Title CHAIR
Signature Date 2/26/19

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