FORM 1023-EZ for THE CRUTCHFIELD BELTON ORGAN TRANSPLANT FOUNDATION

Field Data
EIN 46-1821493
Case Number EO-2016349-000389
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE CRUTCHFIELD BELTON ORGAN TRANSPLANT FOUNDATION
Organization’s Mailing Address 1016 HYACINTH AVE E
City SAINT PAUL
State MN
ZIP 55106
Accounting period End 12
Primary contact name CHRIS CRUTCHFIELD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL BELTON
PRESIDENT
5020 UPTON AVE SOUTH
MINNEAPOLIS MN 55410

Officer/Director/Trustee Two

CHRISTOPHER CRUTCHFIELD
VICE PRESIDENT
1016 HYACINTH AVENUE E
SAINT PAUL MN 55106

Officer/Director/Trustee Three

MAURICE NINS
SECRETARY
1375 JULIET AVENUE
SAINT PAUL MN 55105

Officer/Director/Trustee Four

BROOKE BLAKEY
TREASURER
478 AURORA
SAINT PAUL MN 55103

Organization’s website WWW.CBOTF.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/14/2013
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: 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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