FORM 1023-EZ for SEVA HEALTH CENTER FOR WELLBEING INC

Field Data
EIN 87-1664668
Case Number EO-2021235-000531
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SEVA HEALTH CENTER FOR WELLBEING INC
Organization’s Mailing Address 400 SOUTH PAGE STREET
City MONONA
State IA
ZIP 52159
Accounting period End 12
Primary contact name JESSICA GOLTZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JESSICA GOLTZ
PRESIDENT
400 SOUTH PAGE STREET
MONONA IA 52159

Officer/Director/Trustee Two

HEIDI DICKMAN
SECRETARY
15481 JASPER AVE
MCGREGOR IA 52157

Officer/Director/Trustee Three

NICOLE DENNLER
TREASURER
507 1ST STREET NW
ELKADER IA 52043

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/9/2021
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 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 No
Signature Name JESSICA GOLTZ
Signature Title PRESIDENT
Signature Date 8/20/2021

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