FORM 1023-EZ for REGEN NORTHLAND

Field Data
EIN 47-5615354
Case Number EO-2016154-000157
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name REGEN NORTHLAND
Organization’s Mailing Address 8874 HIGHWAY 25
City ANGORA
State MN
ZIP 55703
Accounting period End 12
Primary contact name DESIREE YOURCZEK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JESSALYN SABIN
DIRECTOR
807 1ST AVE NW
CHISHOLM MN 55719

Officer/Director/Trustee Two

DESIREE YOURCZEK
DIRECTOR
8874 HIGHWAY 25
ANGORA MN 55703

Officer/Director/Trustee Three

WAYNE KANGAS
DIRECTOR
2632 7TH AVE E
HIBBING MN 55746

Organization’s website
Organization’s email REGENIRONRANGE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/14/2015
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S30 - Economic Development
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 Yes
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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