FORM 1023-EZ for COMMUNITY WELLNESS ACTION COUNCIL

Field Data
EIN 37-1756022
Case Number EO-2015166-000165
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COMMUNITY WELLNESS ACTION COUNCIL
Organization’s Mailing Address 900 5TH ST
City INTERNATIONAL FALLS
State MN
ZIP 56649
Accounting period End 12
Primary contact name ANNA DEHLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ALLISON OHARA
PRESIDENT
3551 TOWN ROAD 415
INTERNATIONAL FALLS MN 56649

Officer/Director/Trustee Two

NISSA FOUGNER
TREASURER
1400 HIGHWAY 71
INTERNATIONAL FALLS MN 56649

Officer/Director/Trustee Three

DEAN COWMAN
VICE PRESIDENT
1814 5TH AVE EAST
INTERNATIONAL FALLS MN 56649

Officer/Director/Trustee Four

LINDSI BARNHART
SECRETARY
127 RIVERVIEW BLVD
INTERNATIONAL FALLS MN 56649

Officer/Director/Trustee Five

ANNA DEHLER
VOTING MEMBER
2009 COUNTY ROAD
INTERNATIONAL FALLS MN 56649

Organization’s website N/A
Organization’s email FALLSCWAC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/5/2014
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: Yes
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 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 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
Signature Title
Signature Date

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