FORM 1023-EZ for HEALTH EMPOWERMENT SERIES

Field Data
EIN 84-2818054
Case Number EO-2019347-000206
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALTH EMPOWERMENT SERIES
Organization’s Mailing Address 437 W MORGAN COURT
City MOUNTAIN HOUSE
State CA
ZIP 95391
Accounting period End 8
Primary contact name SHANNON PATIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHERYL SIMS
CEO
437 W MORGAN COURT
MOUNTAIN HOUSE CA 95391

Officer/Director/Trustee Two

SHANNON PATIN
CFO
437 W MORGAN COURT
MOUNTAIN HOUSE CA 95391

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/12/2019
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T31 - Community Foundations
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 Yes
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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 CHERYL SIMS
Signature Title CEO
Signature Date 12/11/2019

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