FORM 1023-EZ for HEADWATERS COMMUNITY ARTS INSTITUTE
| Field | Data |
|---|---|
| EIN | 82-2426426 |
| Case Number | EO-2019288-000586 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | HEADWATERS COMMUNITY ARTS INSTITUTE |
| Organization’s Mailing Address | PO BOX 848 |
| City | THREE FORKS |
| State | MT |
| ZIP | 59752 |
| Accounting period End | 12 |
| Primary contact name | SHELLY WILLIAMS |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
SHELLY WILLIAMS
PRESIDENT
PO BOX 821
THREE FORKS MT 59752
Officer/Director/Trustee Two
SHELBI KREUTZER
VICE PRESIDENT/DIRECTOR OF DANCE
PO BOX 883
THREE FORKS MT 59752
Officer/Director/Trustee Three
AMY LABAN
SECRETARY
PO BOX 103
THREE FORKS MT 59752
Officer/Director/Trustee Four
MICHAEL BERTRAND
BOARD OF DIRECTORS
2462 SUNDOWN VALLEY RD
THREE FORKS MT 59752
Officer/Director/Trustee Five
SHELLY PAYE
BOARD OF DIRECTORS
11225 US HWY 287
THREE FORKS MT 59752
| Organization’s website | NA |
|---|---|
| Organization’s email | HCAITHREEFORKS@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 7/14/17 |
| Organization Incorporation State | MT |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | A62 - Dance |
| 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 | Yes |
| Donation of funds | Yes |
| 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 | SHELLY WILLIAMS |
| Signature Title | PRESIDENT |
| Signature Date | 10/13/19 |
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