FORM 1023-EZ for SEA GLASS RETREATS INC

Field Data
EIN 84-3121306
Case Number EO-2019346-000149
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SEA GLASS RETREATS INC
Organization’s Mailing Address 706 WALNUT DELL ROAD
City PLATTEVILLE
State WI
ZIP 53818
Accounting period End 12
Primary contact name ROXANNE ADAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROXANNE ADAMS
PRESIDENT
706 WALNUT DELL ROAD
PLATTEVILLE WI 53818

Officer/Director/Trustee Two

AISSA LYNN ACOSTA
SECRETARY
144 CHRISTIAN DRIVE
CLEVELAND TN 37312

Officer/Director/Trustee Three

MICHAEL HERRERA
TREASURER
706 WALNUT DELL ROAD
PLATTEVILLE WI 53818

Organization’s website
Organization’s email ROX@SEAGLASSRETREATS.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/13/2019
Organization Incorporation State WI
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: 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 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 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 ROXANNE ADAMS
Signature Title PRESIDENT
Signature Date 12/9/2019

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