FORM 1023-EZ for SUMMIT WELL INC

Field Data
EIN 84-2124366
Case Number EO-2019172-000240
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SUMMIT WELL INC
Organization’s Mailing Address 3771 LADUKE ST
City BOZEMAN
State MT
ZIP 59718
Accounting period End 12
Primary contact name DAN KOLTZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAN KOLTZ
PRESIDENT
3771 LADUKE ST
BOZEMAN MT 59718

Officer/Director/Trustee Two

REBECCA KOLTZ
SECRETARY
3771 LADUKE ST
BOZEMAN MT 59718

Officer/Director/Trustee Three

DAWN TARABOCHIA
DIRECTOR
216 MINERAL AVE
BOZEMAN MT 59718

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/17/19
Organization Incorporation State MT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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 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 DAN KOLTZ
Signature Title PRESIDENT
Signature Date 6/19/19

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