FORM 1023-EZ for THE ROUNDTABLE WELLNESS FOUNDATIONINC

Field Data
EIN 84-5172758
Case Number EO-2020086-000118
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE ROUNDTABLE WELLNESS FOUNDATIONINC
Organization’s Mailing Address 904 SOUTH STREET
City LAFAYETTE
State IN
ZIP 47901
Accounting period End 12
Primary contact name NOAH J STERN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RENEE TILT
DIRECTOR PRESIDENT TREASURER
2033 TAMPA DRIVE
WEST LAFAYETTE IN 47906

Officer/Director/Trustee Two

WILLIAM TILT
DIRECTOR
4500 LOCHAN COURT
LAFAYETTE IN 47905

Officer/Director/Trustee Three

ANNA MCKEAN
DIRECTOR SECRETARY
110 BRITTANY LANE
MONTICELLO IN 47960

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/10/2020
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F53 - Eating Disorder, Addiction
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 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 RENEE TILT
Signature Title DIRECTOR PRESIDENT TREASURER
Signature Date 3/24/2020

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