FORM 1023-EZ for SELDOVIA COMMUNITY MEDICAL CLINIC INCORPORATED

Field Data
EIN 47-1959672
Case Number EO-2014276-000262
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SELDOVIA COMMUNITY MEDICAL CLINIC INCORPORATED
Organization’s Mailing Address 259 SELDOVIA STREET BOX 206
City SELDOVIA
State AK
ZIP 99663-0206
Accounting period End 12
Primary contact name KRIS W LETHIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KRIS LETHIN
DIRECTOR
175 MAIN STREET
SELDOVIA AK 99663-0264

Officer/Director/Trustee Two

SUE CHRISTIANSEN
DIRECTOR
259 SELDOVIA STREET
SELDOVIA AK 99663-0206

Officer/Director/Trustee Three

MARTHA COTTON
DIRECTOR
259 SELDOVIA STREET
SELDOVIA AK 99663-0206

Organization’s website
Organization’s email KWLETHIN@DANCINGEAGLES.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/29/2014
Organization Incorporation State AK
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 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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