FORM 1023-EZ for MONTANA OUTREACH CLINIC

Field Data
EIN 81-4276608
Case Number EO-2016309-000144
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MONTANA OUTREACH CLINIC
Organization’s Mailing Address 321 MEAGHER AVENUE
City BOZEMAN
State MT
ZIP 59718
Accounting period End 12
Primary contact name CHARLEEN MCINNIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHARLEEN MCINNIS
PRESIDENT
321 MEAGHER AVENUE
BOZEMAN MT 59718

Officer/Director/Trustee Two

TIM MCINNIS
VICE PRESIDENT
321 MEAGHER AVENUE
BOZEMAN MT 59718

Officer/Director/Trustee Three

LAURIE HARMON
SECRETARY/TREASURER
157 SANDPIPER LOOP
HELENA MT 59602

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/17/2016
Organization Incorporation State MT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
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 Yes
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
Signature Title
Signature Date

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