FORM 1023-EZ for ROCKY MOUNTAIN MEDICAL FOUNDATION

Field Data
EIN 83-3282499
Case Number EO-2019038-000690
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ROCKY MOUNTAIN MEDICAL FOUNDATION
Organization’s Mailing Address PO BOX 20858
City BILLINGS
State MT
ZIP 59104
Accounting period End 12
Primary contact name LARRY MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LARRY MILLER
PRESIDENT
5228 BLACK STONE CIRCLE
BILLINGS MT 59106

Officer/Director/Trustee Two

JOSH GOLL
SECRETARY, TREASURER
2035 YELLOWSTONE AVENUE
BILLINGS MT 59102

Officer/Director/Trustee Three

NIKI MERANCIK
VICE PRESIDENT
902 3RD AVENUE
BILLINGS MT 59044

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/23/19
Organization Incorporation State MT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
Organization’s purpose Charitable: Yes
Religious: No
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 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 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 LARRY MILLER
Signature Title PRESIDENT
Signature Date 2/1/19

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