FORM 1023-EZ for SUMMIT COUNTY CLUBHOUSE

Field Data
EIN 83-3917769
Case Number EO-2019073-000401
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SUMMIT COUNTY CLUBHOUSE
Organization’s Mailing Address 1720 CANYON DRIVE
City PARK CITY
State UT
ZIP 84098
Accounting period End 12
Primary contact name ED RUTAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SALLY JABLON
DIRECTOR
2366 GOOD TRUMP COURT
PARK CITY UT 84068

Officer/Director/Trustee Two

EVE STANGER
DIRECTOR
9014 FLINT WAY
PARK CITY UT 84098

Officer/Director/Trustee Three

STEPHEN SPALDING
DIRECTOR
3025 LOWER SADDLEBACK ROAD
PARK CITY UT 84098

Officer/Director/Trustee Four

ROBERT YOUNGBERG
LEGAL COUNSEL
3093 FAWN DRIVE
PARK CITY UT 84098

Officer/Director/Trustee Five

EDWIN RUTAN
EXECUTIVE DIRECTOR
7120 CANYON DRIVE
PARK CITY UT 84098

Organization’s website
Organization’s email RUTANS@COMCAST.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/8/19
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
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 ROBERT YOUNGBERG
Signature Title LEGAL COUNSEL
Signature Date 3/12/19

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