FORM 1023-EZ for SQUARE ONE INC

Field Data
EIN 83-2402363
Case Number EO-2018309-000305
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SQUARE ONE INC
Organization’s Mailing Address 1114 RUMSEY AVE
City CODY
State WY
ZIP 82414
Accounting period End 12
Primary contact name DAVID TAYLOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID TAYLOR
PRESIDENT
1114 RUMSEY AVE
CODY WY 82414

Officer/Director/Trustee Two

STEVE SIMONTON
VICE PRESIDENT
1114 RUMSEY AVE
CODY WY 82414

Officer/Director/Trustee Three

LESLIE ROSE
SECRETARY/TREASURER
1114 RUMSEY AVE
CODY WY 82414

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/2/18
Organization Incorporation State WY
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 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 DAVID TAYLOR
Signature Title PRESIDENT
Signature Date 11/1/18

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