FORM 1023-EZ for STILL WATERS RETREAT

Field Data
EIN 47-2794658
Case Number EO-2015029-000225
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name STILL WATERS RETREAT
Organization’s Mailing Address 320 ATCHISON STREET
City SEALY
State TX
ZIP 77474
Accounting period End 12
Primary contact name HEIDI HEWITT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOHN ROSSELLI
DIRECTOR
320 ATCHISON STREET
SEALY TX 77474

Officer/Director/Trustee Two

GIOVANNI ROSSELLI
DIRECTOR
3658 MAIN PLAZA DRIVE
HOUSTON TX 77025-5946

Officer/Director/Trustee Three

SAMUEL WALTMAN JR
DIRECTOR
28131 INDIGO CREEK COURT
FULSHEAR TX 77441

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/14/2015
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
Organization’s purpose Charitable: Yes
Religious: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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