FORM 1023-EZ for ELDERSERVE INC

Field Data
EIN 42-1512665
Case Number EO-2018120-000520
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ELDERSERVE INC
Organization’s Mailing Address 401W GREENEWOOD RD
City JEFFERSON
State IA
ZIP 50129
Accounting period End 6
Primary contact name LINDA ROSS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LINDA ROSS
BOARD CHAIR
800 W ADAMS ST
JEFFERSON IA 50129-1414

Officer/Director/Trustee Two

SHARON STOLINE
VICE CHAIR
304 EDGEWOOD AVE
JEFFERSON IA 50129

Officer/Director/Trustee Three

KATHY KING
SECRETARY
1204 SOUTHFIELD DR
JEFFERSON IA 50129

Officer/Director/Trustee Four

ESTHER KIRBY
TREASURER
700 S GRIMMELL RD
JEFFERSON IA 50129

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/9/79
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K34 - Congregate Meals
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 LINDA ROSS
Signature Title BOARD CHAIR
Signature Date 4/26/18

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