FORM 1023-EZ for WELLCONNECT SE MINNESOTA

Field Data
EIN 83-3359160
Case Number EO-2019093-000294
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WELLCONNECT SE MINNESOTA
Organization’s Mailing Address PLUMMER 4 02 200 1ST STREET SW
City ROCHESTER
State MN
ZIP 55905
Accounting period End 12
Primary contact name LORI CHRISTIANSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUE DEGALLIER
PRESIDENT/CHAIRPERSON
111 MARKET STREET SUITE 3D
WINONA MN 55987

Officer/Director/Trustee Two

NICOLE GUERTON
TREASURER
5420 KENSINGTON LANE NW
ROCHESTER MN 55901

Officer/Director/Trustee Three

SUE DAVIES
VICE PRESIDENT
3998 AUTUMN LAKE COURT SW
ROCHESTER MN 55902

Officer/Director/Trustee Four

KARI SHAFER
SECRETARY
2337 PINEVIEW COURT
RED WING MN 55066

Officer/Director/Trustee Five

LORI CHRISTIANSEN
DIRECTOR
25334 COUNTY HIGHWAY 34
KASSON MN 55944

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/27/18
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 LORI CHRISTIANSEN
Signature Title DIRECTOR
Signature Date 4/1/19

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