FORM 1023-EZ for PANGUITCH QUILT WALK RETREAT

Field Data
EIN 47-2952821
Case Number EO-2015147-000067
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PANGUITCH QUILT WALK RETREAT
Organization’s Mailing Address 162 SOUTH 300 WEST
City PANGUITCH
State UT
ZIP 84759
Accounting period End 12
Primary contact name JERI LU HOUSTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JERILU HOUSTON
DIRECTOR
162 SOUTH 300 WEST
PANGUITCH UT 84759

Officer/Director/Trustee Two

RANDI MILLER
OFFICER
95 NORTH 100 EAST
PANGUITCH UT 84759

Officer/Director/Trustee Three

DIANNE FULLMER
OFFICER
270 WEST 300 SOUTH
PANGUITCH UT 84759

Officer/Director/Trustee Four

SHANNON FAWSON
OFFICER
103 EAST BLUE MEADOW
PANGUITCH UT 84759

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/6/2014
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
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 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 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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